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Traumatic Experiences Associated With Endometriosis

Traumatic experiences are independently associated with endometriosis, according to a study published online Feb. 5 in JAMA Psychiatry.

Dora Koller, Ph.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues examined the relationship between traumatic experiences and endometriosis. The analysis included individual-level genotypic and phenotypic data from 8,276 patients with endometriosis and 240,117 female controls participating in the U.K. Biobank, as well as genome-wide information from a large meta-analysis.

The researchers found that women with endometriosis were more likely to report childhood and adulthood traumatic experiences and stressful events (e.g., contact trauma odds ratio, 1.28). An association was seen between endometriosis and emotional and physical trauma and sexual trauma in a latent-class analysis. Genetic correlation analyses revealed a link between endometriosis and multiple trauma-related outcomes, including posttraumatic stress disorder and childhood maltreatment. There was no interaction between polygenic risk scoring and different types of trauma events.

"The present study comprehensively investigated the impact of childhood and adulthood traumatic experiences and stressful events on endometriosis," the authors write. "In particular, our findings highlight the potential association between contact traumas and endometriosis, which appears to be independent of the disease genetic predisposition."

One author disclosed being the founder of EndoCare Therapeutics.

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Certain Risk Factors for MS Linked to Pediatric Brain Volume

Genetic and environmental risk factors for multiple sclerosis (MS) are associated with brain volume in childhood, according to a study published online Dec. 10 in the Journal of Neurology, Neurosurgery & Psychiatry.

Casper Louk de Mol, from Erasmus Medical Center in Rotterdam, Netherlands, and colleagues examined whether genetic and childhood environmental risk factors for MS have an impact on neurodevelopment before the typical age of onset for MS. In a large, population-based childhood cohort without MS diagnoses, associations and interactions of genetic and environmental risk factors for MS were examined with brain magnetic resonance imaging outcomes, including volumetric and diffusion data at ages 9 and 13 years. Genetic burden was assessed using polygenic risk scores (PRS), and environmental factors were examined at age 5 years.

Genetic data were available for 2,817 and 2,970 participants with volumetric and diffusion data, respectively. The researchers found a positive association for the MS-PRS with Epstein-Barr virus (EBV) viral capsid antigen titers among EBV-positive children (β = 0.15). MS-PRS was negatively associated with subcortical gray matter volume (β = −0.03). There was a negative link for the interaction between the MS-PRS and household parental smoking with total brain volume (β = −0.21) and thalamic volume (β = −0.22); lower volumes were seen in association with higher MS-PRS and household smoking.

"How this increased vulnerability influences other MS risk factors may open a window for prevention of MS by limiting childhood exposure to household smoking or other toxic exposures associated with MS (i.e., household chemicals), and should be a focus for further studies," the authors write.

Two authors disclosed ties to the pharmaceutical industry.

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Study Looks at Impact of Children's Exposure to Lead in the United States

Children's exposure to lead in the United States has had a significant impact on mental illness symptomatology and disadvantageous personality differences, according to a study published online Dec. 4 in the Journal of Child Psychology and Psychiatry.

Michael J. McFarland, Ph.D., from Florida State University in Tallahassee, and colleagues combined serial, cross-sectional blood-lead level (BLL) data from National Health and Nutrition Examination Surveys with historic leaded-gasoline data to estimate U.S. childhood BLLs from 1940 to 2015. Population mental health symptom elevations from known lead-psychopathology associations were calculated.

Assuming the published lead-psychopathology associations are causal, the researchers estimated that the U.S. population gained 602 million General Psychopathology factor points arising from leaded gasoline by 2015, reflecting an increase of 0.13 standard deviations in overall liability to mental illness and an estimated 151 million excess mental disorders due to exposure to lead. Standard deviation increases of 0.64 and 0.42 in population-level internalizing symptoms and attention-deficit/hyperactivity disorder symptoms, respectively, were identified on examination of specific disorder-domain symptoms. A 0.14-standard deviation increase in population-level neuroticism was seen, as was a 0.20-standard deviation decrease in conscientiousness. Cohorts born from 1966 to 1986 had the most pronounced lead-associated mental health and personality differences.

"A significant burden of mental illness symptomatology and disadvantageous personality differences can be attributable to U.S. children’s exposure to lead over the past century," the authors write. "The contribution of legacy lead exposures to population health and disease may be much larger than previously assumed."

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Different Forms of Childhood Adversity Tied to Different Psychiatric Problems

Distinct forms of traumatic and adverse childhood experiences (TRACEs) differentially moderate developmental changes in psychiatric risk and cognitive ability in different ways, according to a study published online Oct. 23 in JAMA Psychiatry.

Justin D. Russell, Ph.D., from the University of Wisconsin School of Medicine & Public Health in Madison, and colleagues characterized unique components of 268 commonly co-occurring TRACEs and examined moderation of longitudinal change in mental health and cognitive development during adolescence. The analysis included 11,876 youth-caregiver dyads who completed up to four annual behavioral assessments (2016 to 2021) as part of the ongoing Adolescent Brain Cognitive Development study.

The researchers found that TRACEs fell into into eight thematic adversity components (e.g., family conflict, interpersonal violence). Exposure to nearly every adversity component at baseline was associated with poorer mental health and diminished cognitive ability. Different forms of adversity were variably linked to both increases and decreases in internalizing and externalizing problems over time. For example, during early adolescence, while peer aggression and family conflict were associated with increases in both internalizing and externalizing problems, community threat and poverty were linked to decreased problems, potentially representing adaptive suppression of symptoms. During early adolescence, adversity types related to resource deprivation (e.g., poverty, caregiver maladjustment) were associated with declines in cognitive ability.

"These findings hold important implications for advancing prevention and treatment of mental health problems in adversity-exposed youth," the authors write.

One author disclosed ties to the pharmaceutical industry.

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Inflammation in Childhood Linked to Onset of Mental Health Disorders

Low-grade systemic inflammation across childhood and adolescence is associated with the subsequent onset of mental health disorders, according to a study published online Aug. 21 in JAMA Psychiatry.

Edward R. Palmer, M.B.B.S., from the University of Birmingham in the United Kingdom, and colleagues examined trajectories of inflammation, as measured by C-reactive protein (CRP), in children and adolescents using data from the U.K.-based Avon Longitudinal Study of Parents and Children; inflammation was assessed at ages 9, 15, and 17 years. Data were included for 6,556 participants; outcomes were assessed at age 24 years.

The researchers identified three classes of inflammation: persistently low CRP levels (6,109 individuals) and persistently elevated CRP levels peaking at 9 years and 17 years (early peak, 197 individuals; late peak, 250 individuals). Compared with participants with persistently low CRP, participants in the early-peak group had an increased risk for psychotic disorder (odds ratio, 4.60), a higher risk for severe depression (odds ratio, 4.37), and higher Homeostasis Model Assessment scores (β = 0.05). No associations with outcomes were seen for the late-peak group.

"This study adds new information about the chronicity and timing of inflammation predating illness and provides insight into the co-occurrence of related cardiometabolic disorders," the authors write.

One author disclosed ties to the pharmaceutical and health care industries.

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Child Maltreatment, Particularly Neglect, Tied to Cognitive Deficits

Childhood maltreatment is associated with later cognitive difficulties, according to a study published in the September issue of The Lancet Psychiatry.

Andrea Danese, M.D., Ph.D., from King's College London, and Cathy Spatz Widom, Ph.D., from the John Jay College City University of New York in New York City, evaluated associations of objective and subjective measures of maltreatment with cognitive abilities within the same individuals. Analysis included 1,179 individuals with both objective, court-documented evidence of childhood maltreatment, subjective self-reports of individuals’ histories at age 29 years, and cognitive testing between ages 29 years and 41 years.

The researchers found that participants with objective measures of childhood maltreatment showed pervasive cognitive deficits versus those without objective measures (Quick Test: β = –7.97; Wide Range Achievement Test-Revised: β = –7.41; Matrix Reasoning Test: β = –3.86; Trail Making Test Part B: β = 3.66; and Trail Making Test Part A: β = 2.92). Associations with cognitive deficits were limited to objective measures of neglect. For participants with subjective measures of childhood maltreatment, there were no differences in cognitive deficits from those without subjective measures. Cognitive deficits did not explain associations between different measures of maltreatment and later psychopathology.

"Psychopathology associated with maltreatment is unlikely to emerge because of cognitive deficits, but might instead be driven by individual appraisals, autobiographical memories, and associated schemas," the authors write.

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ADHD Medications Also Improve Quality of Life

Medications for attention-deficit/hyperactivity disorder (ADHD) are effective at improving quality of life in people with the disorder, according to a review recently published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Alessio Bellato, Ph.D., from the University of Southampton in the United Kingdom, and colleagues conducted a systematic review and meta-analysis to quantify the effect of ADHD medication on quality of life.

Based on 17 randomized controlled trials (5,388 participants), the researchers found that amphetamines (Hedge's g = 0.51), methylphenidate (Hedge's g = 0.38), and atomoxetine (Hedge's g = 0.30) were significantly more efficacious than placebo in improving quality of life in people with ADHD, with moderate effect size. These effects were not moderated by the length of intervention for atomoxetine, and did not differ between children/adolescents and adults.

"It could be that reducing the core symptoms of ADHD (inattention, hyperactivity, impulsivity) leads to more efficient task management and this results in better academic and professional outcomes," Bellato said in statement. "Medications may also help to stabilize emotional dysregulation, which might promote emotional well-being and higher self-esteem."

One author disclosed ties to the pharmaceutical industry.

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Moving Neighborhoods in Childhood May Increase Risk for Depression in Adulthood

Moving during childhood may increase the risk for later depression, according to a study published online July 17 in JAMA Psychiatry.

Clive E. Sabel, Ph.D., from Aarhus University in Denmark, and colleagues evaluated whether changing neighborhood income deprivation and residential moves during childhood are associated with the risk for receiving a diagnosis of depression in adulthood. The analysis included 1.1 million people born in Denmark from 1982 through 2003 with follow-up for 15 years.

The researchers found that people living in deprived areas during childhood had an increased risk for depression (incidence rate ratio, 1.10). When fully adjusting for individual-level factors, the risk was lessened (incidence rate ratio, 1.02), yielding an increase of 2 percent in depression incidence for each one standard deviation increase in income deprivation. Independent of neighborhood deprivation status, moving during childhood was associated with significantly higher rates of depression in adulthood versus not moving (incidence rate ratio, 1.61 for two or more moves after full adjustment).

"This study suggests that rather than solely high neighborhood income deprivation in childhood being associated with onset of depression during adulthood, a settled home environment in childhood may have a protective association," the authors write. "Policies that enable and support settled childhoods should be promoted."

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FDA Approves First Liquid, Nonstimulant ADHD Treatment

The U.S. Food and Drug Administration has approved once-daily Onyda XR (clonidine hydrochloride) as the first liquid, nonstimulant treatment for attention-deficit/hyperactivity disorder (ADHD).

The once-a-day, extended-release, oral suspension treatment is a centrally acting alpha2-adrenergic agonist. It has nighttime dosing for the treatment of ADHD as a monotherapy or as an adjunctive therapy to approved central nervous system stimulant medications in pediatric patients ≥6 years.

Onyda XR is contraindicated in patients with history of a hypersensitivity reaction to clonidine. As monotherapy, the most common adverse reactions (incidence ≥5 percent and twice the rate of placebo) include somnolence, fatigue, irritability, nightmare, insomnia, constipation, and dry mouth. For adjunct therapy, the most common adverse reactions (incidence ≥5 percent and twice the rate of placebo) include somnolence, fatigue, decreased appetite, and dizziness.

"People with ADHD require a range of therapeutic options that are designed for their individual needs, because not every medication or type of therapy works for every patient," Ann Childress, M.D., president of the Center for Psychiatry and Behavioral Medicine in Las Vegas, said in a statement. "The approval of Onyda XR, the only liquid nonstimulant ADHD medication, with nighttime dosing that shifts the release profile, is a convenient option for patients needing better ADHD control."

Approval of Onyda XR was granted to Tris Pharma.

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Pharmacological Treatment of ADHD May Cut Some Forms of Criminality

WEDNESDAY, May 29, 2024 (HealthDay News) -- Pharmacological treatment may reduce some types of criminality among adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD), according to a study published online in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Tarjei Widding-Havneraas, from Haukeland University Hospital in Bergen, Norway, and colleagues estimated causal effects of pharmacological treatment of ADHD on four-year criminal outcomes. Analysis included registry data from 5,624 patients (aged 10 to 18 years) diagnosed with ADHD between 2009 and 2011, their use of ADHD medication, and subsequent criminal charges.

The researchers found that criminality was higher in patients with ADHD versus the general population. There was variation in medication preference by clinics, which strongly affected patients' treatment. There was a protective effect of pharmacological treatment on violence-related and public order-related charges (numbers needed to treat: 14 and eight, respectively). However, there was no association seen between treatment and drug-, traffic-, sexual-, or property-related charges.

"In conclusion, this is the first study to demonstrate causal effects of pharmacological treatment of ADHD on some types of crimes in a population-based natural experiment," the authors write. "Pharmacological treatment of ADHD reduced crime related to impulsive-reactive behavior in patients with ADHD on the margin of treatment. No effects were found on crimes requiring criminal intent, conspiracy, and planning."

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Short Sleep Duration Throughout Childhood Tied to Psychosis Risk in Young Adulthood

WEDNESDAY, May 29, 2024 (HealthDay News) -- Persistent shorter sleep duration across childhood may be a risk factor for subsequent psychosis in young adulthood, according to a study published online May 8 in JAMA Psychiatry.

Isabel Morales-Muñoz, Ph.D., from University of Birmingham in the United Kingdom, and colleagues examined the association of persistent shorter sleep duration across childhood (ages 6, 18, and 30 months and at 3.5, 4 to 5, 5 to 6, and 6 to 7 years) with psychosis in young adulthood (age 24 years). Analysis included 12,394 children and 3,962 young adults.

The researchers found that individuals with persistent shorter nighttime sleep duration across childhood were more likely to develop psychotic disorder (PD; odds ratio, 2.50) and psychotic experiences (PEs; odds ratio, 3.64) at age 24 years. Increased levels of interleukin-6 at 9 years of age partially mediated the associations between persistent shorter sleep duration and PD (bias-corrected estimate = 0.003) and PEs (bias-corrected estimate = 0.002) in young adulthood, but no such relationship was seen for C-reactive protein at 9 or 15 years.

"Our results indicate that although significant, the size of the association and the proportion of the association mediated was low, which indicates that other factors are also potentially explaining these associations," the authors write. "Future studies should further explore the specific role of inflammation as a potential mediating factor in the prospective associations between sleep and psychosis, together with other potentially relevant mediating factors."

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U-Shaped Link Detected Between Adolescent BMI and Mental Health

FRIDAY, May 17, 2024 (HealthDay News) -- There is a U-shaped association between adolescent body mass index (BMI) and mental health, according to a study published online May 15 in JAMA Psychiatry.

Shanquan Chen, Ph.D., from the London School of Hygiene & Tropical Medicine, and colleagues estimated the association between BMI and mental health and examined changes from 2002 to 2018 in a repeated multicountry cross-sectional study. Data were obtained from the Health Behaviour in School-aged Children survey in Europe and North America, including a study population of 1,036,869 adolescents (527,585 girls) aged 11 to 15 years.

The researchers identified a U-shaped association between BMI and mental health. Compared with those with healthy weight, adolescents with low body mass, overweight, or obesity had increased psychosomatic symptoms (unstandardized β, 0.14, 0.27, and 0.62, respectively), while fewer symptoms were seen for adolescents with underweight (β, −0.18). Across different years, sex, and grade, the association was observed. Psychosomatic concerns increased significantly in 2006, 2010, 2014, and 2018 compared with 2002 (unstandardized β, 0.19, 0.14, 0.48, and 0.82, respectively). Significantly higher psychosomatic concerns were seen for girls than boys (unstandardized β, 2.27). Psychosomatic concerns increased significantly in middle and high school versus primary school (unstandardized β, 1.15 and 2.12, respectively).

"These insights can inform public health and school programs, emphasizing correcting body image misconceptions, encouraging healthy weight, and creating supportive peer environments," the authors write.

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321,566 Children Lost a Parent to Drug Overdose in 2011 to 2021

WEDNESDAY, May 8, 2024 (HealthDay News) -- From 2011 to 2021, an estimated 321,566 children lost a parent to drug overdose in the United States, according to a study published online May 8 in JAMA Psychiatry.

Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H., from the Substance Abuse and Mental Health Services Administration in Rockville, Maryland, and colleagues estimated the number and rate of children who have lost a parent to drug overdose from 2011 to 2021 in a cross-sectional study of U.S. community-dwelling persons.

The researchers found that 649,599 adults aged 18 to 64 years died from a drug overdose from 2011 to 2021. An estimated 321,566 community-dwelling children lost a parent ages 18 to 64 years due to drug overdose among these decedents. From 2011 to 2021, there was an increase seen in the rate of community-dwelling children who lost a parent to drug overdose, from 27.0 to 63.1 per 100,000. The highest rates were seen among children of non-Hispanic American Indian or Alaska Native individuals (187.1 per 100,000 versus 76.5 and 73.2 among non-Hispanic White and non-Hispanic Black individuals, respectively). For all parental age, sex, and race and ethnicity groups, rates increased consistently each year, but the largest average annual percent change occurred in non-Hispanic Black parents aged 18 to 25 years (23.8 percent).

"Program and policy planning should ensure that responses to the overdose crisis integrate the full burden of drug overdose on families and children, including the economic, social, educational, and physical and behavioral health care needs of children who have lost parents to overdose," the authors write.

One author reported long-term stock holdings from General Electric, 3M Companies, and Pfizer.

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Activation in Fronto-Parietal Networks Normalizes After Cognitive Therapy

THURSDAY, Feb. 1, 2024 (HealthDay News) -- For unmedicated youths with anxiety disorder, activation in fronto-parietal networks may normalize after cognitive behavioral therapy (CBT), according to a study published online Jan. 24 in The American Journal of Psychiatry.

Simone P. Haller, D.Phil., from the National Institute of Mental Health in Bethesda, Maryland, and colleagues examined the brain mechanisms associated with symptom change following CBT among unmedicated youths diagnosed with an anxiety disorder. Participants underwent 12 weeks of CBT as part of two randomized clinical trials. Before and after treatment, a threat-processing task was completed by 69 youths with anxiety disorder during magnetic resonance imaging. During the same time span, 62 age-matched healthy comparison youths also completed two scans. The stability of anxiety-related neural differences was tested in the absence of treatment in an additional sample of 87 youths at temperamental risk for anxiety.

The researchers found that across all task conditions, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children before treatment. During the course of treatment, fronto-parietal hyperactivation normalized, while limbic responses remained elevated following treatment. In the at-risk sample, regions showing stable associations with anxiety over time and regions showing treatment-related changes had overlapping clusters.

"The data from this study reveal neural mechanisms that change following the acute effects of CBT for pediatric anxiety, as well as potential subcortical and cortical targets that remain dysfunctional after 12 weeks of CBT," the authors write.

One author reported ties to various medical organizations.

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In Utero Rx Stimulant Exposure Not Tied to Later Neurodevelopmental Issues

THURSDAY, Feb. 1, 2024 (HealthDay News) --Amphetamine/dextroamphetamine and methylphenidate exposure in utero does not appear to increase the risk for childhood neurodevelopmental disorders, according to a study published online Jan. 24 in JAMA Psychiatry.

Elizabeth A. Suarez, Ph.D., M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues evaluated the association between childhood neurodevelopmental disorders and in utero exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD). The analysis included health care utilization data from publicly insured (Medicaid data from 2000 to 2018) and commercially insured (MarketScan Commercial Claims Database data from 2003 to 2020) pregnant individuals aged 12 to 55 years.

The researchers found that when adjusting for measured confounders, amphetamine/dextroamphetamine exposure was not associated with any outcome (autism spectrum disorder: hazard ratio [HR], 0.80 [95 percent confidence interval (CI), 0.56 to 1.14]; ADHD: HR, 1.07 [95 percent CI, 0.89 to 1.28]; any neurodevelopmental disorder: HR, 0.91 [95 percent CI, 0.81 to 1.28]). There was an association seen between methylphenidate exposure and an increased risk for ADHD (HR, 1.43; 95 percent CI, 1.12 to 1.82) but not other outcomes after adjustment (autism spectrum disorder: HR, 1.06 [95 percent CI, 0.62 to 1.81]; any neurodevelopmental disorder: HR, 1.15 [95 percent CI, 0.97 to 1.36]). With stricter control for confounding by maternal ADHD, the association between methylphenidate and ADHD did not persist.

"Given the recent rise in use of stimulant medications for ADHD in adults and during pregnancy, these results are reassuring for patients who depend on these medications throughout pregnancy for control of debilitating ADHD symptoms that interfere with daily functioning," the authors write.

Several authors disclosed ties to industry.

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Study Examines Prevalence of Mental Health Disorders in Childhood

WEDNESDAY, Jan. 31, 2024 (HealthDay News) -- The prevalence of mental health disorders exceeds 11 percent for children and youth aged 5 to 24 years, according to a study published online Jan. 31 in JAMA Psychiatry.

Christian Kieling, M.D., Ph.D., from the Universidade Federal do Rio Grande do Sul in Porto Alegre, Brazil, and colleagues used data from the 2019 Global Burden of Disease study to estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across four age groups (ages 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years).

The researchers found that globally, 293 million of 2,516 million individuals aged 5 to 24 years had at least one mental disorder in 2019; 31 million had an SUD, with a mean prevalence of 11.63 and 1.22 percent for mental disorders and SUDs, respectively. For those aged 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years, the prevalence of mental disorders was 6.80, 12.40, 13.96, and 13.63 percent, respectively. There was variation observed by age groups in the prevalence of each individual disorder; there was also some variation seen in sex-specific patterns by age. Of 153.59 million YLDs, mental disorders accounted for 31.14 million YLDs and SUDs accounted for 4.30 million YLDs (20.27 and 2.80 percent of YLDs from all causes, respectively). Overall, 24.85 percent of all YLDs attributable to mental disorders during the entire life course were recorded before age 25 years.

"Mental health disorders deserve special attention in terms of prevention and intervention in the first decades of life and that one-fifth of the disease-related nonfatal burden in this age range is attributable to mental disorders," the authors write.

Several authors disclosed ties to the pharmaceutical, medical device, and publishing industries.

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Stimulant Treatment for Childhood ADHD Not Linked to Substance Use

TUESDAY, July 11, 2023 (HealthDay News) -- For children with attention-deficit/hyperactivity disorder (ADHD), stimulant treatment is not associated with later frequent substance use by adolescents and young adults, according to a study published online July 5 in JAMA Psychiatry.

Brooke S.G. Molina, Ph.D., from the University of Pittsburgh, and colleagues examined the association of ADHD stimulant treatment in childhood with later adolescent or adult substance use using the Multimodal Treatment Study of ADHD, a multisite study initiated at six sites in the United States and one site in Canada. A total of 567 participants were analyzed. The child participants were recruited between 1994 and 1996 (mean age, 8.5 years) and were assessed repeatedly until a mean age of 25 years for heavy drinking, marijuana use, daily cigarette smoking, and other substance use.

The researchers found that after adjustment for developmental trends in substance use and age, there was no evidence that current or prior stimulant treatment or their interaction were associated with substance use. There was no evidence that more years of stimulant treatment or continuous, uninterrupted stimulant treatment were associated with adulthood substance use in marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors. Findings were the same with an outcome of substance use disorder.

"Although these results contrast with recent conclusions of protection found in other data sets, across all studies the findings lend a measure of comfort in the consistent lack of evidence that stimulant treatment predisposes children with ADHD to later substance use," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Melatonin May Reduce Risk for Intentional Self-Harm in Female Teens

MONDAY, April 3, 2023 (HealthDay News) -- For female adolescents with psychiatric disorders, melatonin use is associated with a reduced risk for intentional self-harm, according to a study published online March 23 in the Journal of Child Psychology and Psychiatry.

Marica Leone, Ph.D., from Janssen Pharmaceutical Companies of Johnson & Johnson and the Karolinska Institutet, both in Solna, Sweden, and colleagues conducted a population-based cohort study including 25,575 youths who initiated melatonin treatment between ages 6 and 18 years. The rate of injuries was examined in the year prior to and following initiation of melatonin treatment.

The researchers found that the rates of body injuries, falls, and transport accidents were comparable in the year prior to and after medication initiation, but the risk for self-harm was highest in the months immediately preceding initiation of melatonin and decreased thereafter. Among adolescents with depression and/or anxiety, this was particularly prominent, with greater absolute risks for girls versus boys. Decreased relative risks for self-harm were seen in the 12 months after medication initiation compared with the last unmedicated month, with an incidence rate ratio of 0.46 in the month following treatment initiation among adolescent girls with psychiatric disorders, after excluding antidepressant users.

"There is currently a youth mental health crisis, and the risk of self-harm and suicide is high," a coauthor said in a statement. "Our findings support the hypothesis that sleep interventions may reduce self-harm in this population, especially in girls."

Two authors disclosed financial ties to the pharmaceutical industry.

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