Game addiction is increasingly acknowledged as a major adolescent mental health concern worldwide. To better understand its development, it is essential to identify both risk and protective factors. However, most existing studies have focused on only a limited number of variables. To address this gap, this study adopted machine learning to identify the most important predictors across individual, family, and school domains.

The analysis was conducted with a sample of 21,239 Chinese parent–adolescent pairs (for parents: 68.92% mothers; Mage = 40.42 years, SD = 5.78 years; for adolescents: 45.00% males; Mage = 13.41 years, SD = 2.14 years). Using the machine learning classification models, this study examined the accuracy of the selected variables in predicting game addiction and explored the relative importance of the studied variables in the prediction process.

Both the Random Forest and XGBoost models achieved accuracies exceeding 0.80 and consistently identified several key predictors of game addiction. Risk factors include high levels of externalizing problems and attention problems, being male, bullying victimization, alienation from parents, parental depression, and a performance-oriented school environment. The protective factors include high levels of perseverance, good academic performance, and academic self-efficacy.

In conclusion, the findings point out the value of using machine learning approaches to uncover the crucial predictors of game addiction, offering important insights for targeted prevention and intervention efforts across individual, familial, and school contexts.

Despite concerns over increasing adolescent loneliness and its lasting negative impact on mental and physical health, global trends and the gender and socioeconomic inequalities remain unclear. The study examined trends in adolescent school loneliness from 2000 to 2022 across 87 countries, analyzing disparities by gender, socioeconomic status, and country-income level.

We analyzed data from the Programme for International Student Assessment, a nationally representative survey of 15-year-olds conducted in 2000, 2003, 2012, 2015, 2018, and 2022. School loneliness was measured by a composite score from six self-reported questions. We used mixed-effects regression modeling and meta-regression to analyze trends by gender, socioeconomic status, and country-income level (low and lower-middle, upper-middle, or high).

Among the 2,155,046 students, 50.8% were girls (n = 1,095,010), and school loneliness increased over time. Although boys initially reported higher school loneliness, girls’ school loneliness increased more rapidly, surpassing boys’ levels around 2012 in high-income countries and around 2018 in upper-middle-income countries. This gender-based reversal was not evident in low- and lower-middle-income countries. Low socioeconomic status was consistently associated with greater school loneliness across genders and across all country-income groups.

Adolescent school loneliness has increased globally over the past two decades, becoming particularly pronounced among girls in wealthier nations, leading to a widening gender gap by 2022. Socioeconomic disadvantages are a common risk factor for higher levels of school loneliness across all income groups. Public health strategies aimed at mitigating global trends in adolescent school loneliness and addressing its socioeconomic and growing gender disparities are warranted.

Suicide is a serious public health issue and the leading non-accidental cause of death among adolescents in Spain. Although a previous suicide attempt is the strongest risk factor for a new attempt, studies focused specifically on adolescent reattempters remain scarce. This study aims to identify modulating factors for suicide reattempts in a clinical adolescent population following an index attempt, using network analysis.

We recruited a total of 287 adolescents aged 12 to 17, treated in emergency services after a recent suicide attempt. Data collection involved structured clinical interviews and validated self-report questionnaires assessing sociodemographic, psychopathological, and behavioral variables. Our network analysis explored significant correlations (r ≥ 0.2) between variables and their relative influence on suicidal behavior, with a particular focus on reattempts (1-year follow-up).

Variables related to emotional and behavioral difficulties, childhood trauma, and depressive symptoms were the most central and influential within the network. In contrast, suicide reattempts and their frequency appeared as peripheral nodes with no significant direct associations. Emotional abuse was associated with a higher total number of suicide attempts, and the Self-Awareness of Mental Health intervention was linked to a longer time before reattempt.

This study highlights the complexity of suicide reattempt risk factors in adolescents, emphasizing the importance of indirect interactions rather than isolated predictors. Incorporating standardized self-report tools may enhance clinical assessment and prevention strategies. Through network analysis, this research offers an innovative perspective to understand the multivariate nature of suicide risk in adolescent populations.

To report the first case of persistent Hyrtl’s fissure with incomplete partition type II malformation causing recurrent meningitis and systematically review all reported cases.

A systematic literature review identified English-language Hyrtl‘s fissure cases. A new case of a 13-year-old with recurrent meningitis and dual anomalies is presented.

Among 24 total cases (22 with age stated), 72.7 per cent were children and 91.7 per cent were unilateral. Common presentations included post-tympanostomy tube cerebrospinal fluid (CSF) otorrhoea (n = 10) and meningitis (n = 8). The new case is the first report of Hyrtl’s fissure with incomplete partition type II, presenting with three meningitis episodes, profound hearing loss, and pulsatile middle-ear effusion and sigmoid sinus thrombosis.

Hyrtl’s novel coexistence with incomplete partition type II raises the possibility of a broader developmental field defect, although this remains speculative given the single-case nature of this report. High-resolution computed tomography is essential for diagnosis, with careful attention to the hypotympanum and subiculum region where the fissure typically terminates. Recurrent meningitis with unilateral hearing loss and pulsatile effusion warrants high suspicion for surgically correctable skull base anomalies. The presence of one anomaly does not exclude the presence of another, and clinicians should evaluate for multiple potential sites of CSF leakage.

Physical activity and team sport participation in adolescence are associated with positive health outcomes, stronger social skills, and improved mental health. However, negative health consequences are frequently associated with contact/collision sports like football. The objective of this study was to examine any change in health-related quality of life (HRQoL) and pediatric well-being among adolescent males after participating in a single season of football.

A cross-sectional study design was utilized in a high school football setting. Participants included Black/African American adolescent male football players (n = 83) from five schools within rural Alabama. Pediatric HRQoL and well-being measures were administered at preseason and postseason, including Life Satisfaction, Emotional Support, Psychological Stress, Physical Stress, Depressive Symptoms, Sleep Disturbance, and Peer Relationships. Based on normative data, participants’ scores were classified as within normal limits (WNL) (T-score = 40–60) or clinically reduced (T-score < 40) or elevated (T-score > 60) depending on orientation of each questionnaire. Each outcome from pre-to-postseason evaluation was compared using a within-persons t-test.

Most participants (69.9–84.3%) had HRQoL/well-being scores WNL and scores remained unchanged at postseason evaluations. However, on average, physical (p = 0.035, d = 0.24) and psychological stress (p = 0.014, d = 0.28) showed small, but significant increases from pre-to-postseason.

Modest increases in physical and psychological stress were found from preseason to postseason. Both football and non-football-related stressors could have contributed to this change. Other HRQoL/well-being scores generally showed no change. Though the health risks associated with contact/collision sports deserve attention, current findings suggest a season of football may not be associated with adverse changes in HRQoL/well-being.

Recently, there has been a significant rise in potency (% tetrahydrocannabinol (THC)) of cannabis products globally. As such, there is a need for a better understanding of the relationship between cannabis potency and mental health outcomes, especially in a developmentally vulnerable population such as adolescents and young adults.

The objective of this scoping review was to summarise existing literature investigating the potency of cannabis products as it relates to mental health outcomes in adolescents and young adults aged 14–25.

Systematic searches of MEDLINE, Embase, CINAHL and PsycINFO were conducted for relevant manuscripts up to October 2025. Following PRISMA-ScR guidelines, retrieved studies were then screened and data extracted by two independent reviewers.

Out of 11 225 studies identified by our searches, 71 were included in the review after screening. Compared with low-potency cannabis, our findings suggest that high-potency cannabis is more strongly associated with severe mental health issues, such as cannabis dependence, psychosis and cognitive deficits.

Overall, it was found that high-potency cannabis use (>15% THC) was associated with a great number and magnitude of adverse mental health outcomes. As such, the potency of cannabis products should be measured in future cannabis research that investigates short- and long-term outcomes. Additionally, the potency of cannabis products should be a consideration in any future cannabis regulatory policy discussions.

Psychotic experiences (PEs) in are associated with elevated risk for mental health difficulties. This study examined predictors of PEs, inclusive of the role of gender, ethnicity, and protective factors.

Data were drawn from a 2021 Planet Youth survey of adolescents (n = 4,005). PEs were measured using the adolescent psychotic symptom screener. Effects of psychosocial predictors on PEs were measured by fitting multivariable logistic regression main effect and joint exposure models.

29.8% reported PEs. Black/Asian/Other minorities had elevated odds (aOR = 1.59, 95% CI 1.26–2.02, p < .001). Increased odds in males, females, undisclosed gender and non-binary/transgender with elevated emotional/behavioural difficulties (aOR = 4.47, 95% CI 3.53–5.67, p < .001; aOR = 3.25, 95% CI 2.59–4.08, p < .001; aOR = 4.83, 95% CI 2.58–9.02, p < .001; aOR = 4.33, 95% CI 2.69–6.97, p < .001 respectively). High odds in undisclosed gender with low emotional/behavioural difficulties (aOR = 4.36, 95% CI 1.50–12.66, p = .007). Lower odds from perceived school/home safety (aOR = 0.69, 95% CI 0.58–0.83, p < .001 and (aOR = 0.81, 95% CI 0.66–0.99, p = .038, respectively). Elevated odds from recent adversities (aOR = 1.91, 95% CI 1.47–2.49, p = .011) attenuated by parental support (aOR = 1.76, 95% CI 1.17–2.65, p < .001). Each additional adversity (>12 months) increased odds (aOR = 1.12, 95% CI 1.07–1.17, p < .001).

Findings highlight the interplay of risk and protective factors in adolescent PEs, with increased vulnerability among minoritized youth. Results support targeted interventions to reduce mental health disparities.

Juvenile nasopharyngeal angiofibroma is a highly vascular benign tumour affecting adolescent males. Our aim was to compare operative outcomes in embolised and non-embolised patients, with emphasis on tumour stage.

A systematic review was conducted using three databases (PubMed, Scopus and Google Scholar) in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Overall, 17 studies with a total of 524 patients met the inclusion criteria. The meta-analysis showed a significant difference in estimated blood loss between embolised and non-embolised groups (overall effect size -685 ml; p < 0.001). Additionally, embolised patients with advanced stage tumours tended to lose less blood during surgery than non-embolised patients (mean of 1551.9 ml vs. 4051.5 ml; p = 0.065).

This systematic review and meta-analysis demonstrate that pre-operative endovascular embolisation provides an operative advantage in patients undergoing juvenile nasopharyngeal angiofibroma surgical resection. A near-significant trend towards greater benefit in higher-stage tumours was observed (p = 0.065), warranting further prospective investigation.

One in five children who undergo cardiac surgery report experiencing moderate to severe pain lasting more than 3 months after surgery which has a significant impact on quality of life. iCanCope with PostOperative Pain (“iCanCope POP”) is a smartphone app that provides adolescents with evidence-based strategies to manage postoperative pain. The goal of this study was to explore the unique needs and pain-management experiences of youth undergoing cardiac surgery to inform the development of a tailored iteration of iCanCope POP.

A descriptive qualitative design using semi-structured interviews and focus groups was conducted with adolescents ages 12–18 who had received cardiac surgery, caregivers of youth undergoing cardiac surgery, and interdisciplinary healthcare providers (HCPs). Qualitative data were inductively and deductively coded using a content analysis approach to outline participants’ pain management experiences and perspectives on the iCanCope POP app.

14 interviews and 1 focus group were completed with 6 children, 6 parents, and 12 HCPs (n = 24 participants). Content analysis resulted in 3 key categories: 1. Riding the rollercoaster of the surgical journey (e.g., ups and downs of pre- and post-operative phases); 2. Postoperative pain experience (e.g., tubes, technologies, and devices; pain management strategies); and 3. App feedback (e.g., usefulness, appropriateness, suggested modifications).

Participants reported significant challenges during the perioperative pediatric cardiac surgery journey and identified potential opportunities for a tailored mobile self-management app to improve their surgical experience. Future research should use these perspectives to inform a new iteration of the iCanCope POP app for youth undergoing cardiac surgery.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

Non-suicidal self-injury (NSSI) is a major clinical and public health issue in adolescence. Although psychological factors such as depression, anxiety and emotion dysregulation have been widely examined, less is known about how pain perception and autonomic reactivity interact with these variables in NSSI.

This study aimed to compare pressure pain threshold (PPT), autonomic responses and psychological characteristics between adolescents with NSSI and healthy controls, and to explore associations between pain perception, psychopathology, emotion regulation and NSSI functions.

Sixty-eight adolescents (34 with NSSI, 34 controls) participated. PPT was assessed using a pressure algometer. Depressive symptoms, anxiety symptoms and emotion regulation difficulties were measured, and NSSI functions were evaluated using a standardised tool. Systolic (SBP)/diastolic blood pressure and heart rate were recorded before and after pain stimulation. Correlational analyses and mixed (repeated measures) analyses of variance were performed.

The NSSI group showed a significantly higher PPT than controls (mean difference 1.43 kg/cm2; 95% CI: 0.64–2.00; p < 0.001). A significant group × time interaction emerged for SBP (η2 = 0.09), indicating a blunted post-pain response in the NSSI group. Emotion regulation difficulties were positively associated with PPT (r = 0.28). PPT was also positively correlated with sensation seeking (r = 0.36), autonomy (r = 0.34) and peer bonding (r = 0.36) functions of NSSI.

Adolescents with NSSI demonstrate elevated pain thresholds and altered autonomic reactivity. These findings highlight the importance of considering pain processing alongside psychological characteristics and NSSI functions in clinical assessment and intervention planning.

Internet-delivered parent-led interventions can be useful for treating anxiety in children and adolescents, and they also help increase access to services while reducing time and cost.

This review aimed to investigate the effects of internet-delivered parent-led interventions on reducing anxiety in children and adolescents.

A search of PubMed, PsycArticles, Cochrane Library, and Google Scholar databases identified 13 studies published between 2013 and 2024, which examined internet-delivered, parent-led interventions targeting anxiety in children.

Internet-delivered parent-led interventions had overall positive effects on reduced anxiety in children and adolescents that could be maintained through follow-up. Interventions directly targeting anxiety symptoms had significant treatment effects.

Internet-delivered parent-led interventions may be effective in reducing anxiety symptoms in children and adolescents, particularly when the intervention directly targets anxiety rather than focusing solely on parenting approaches. Interventions supplemented with therapist support, such as telephone consultations, appear to enhance treatment outcomes and help maintain effects over time. Two-thirds of the included studies had a moderate risk of bias, and one-third had a serious risk of bias. Further studies using rigorous methodologies are needed to strengthen the evidence base.

Self-regulation is central to adolescent emotional and cognitive development, and deficits in self-regulation may associate with depression and anxiety. This scoping review maps the use of the Emotional Go/No-Go (EGNG), Delay Discounting Task (DDT), and Balloon Analogue Risk Task and Youth version (BART) in studies of adolescent depression and anxiety, examines consistency of task implementation, and identifies methodological and geographic gaps.

A PRISMA-ScR–compliant search was conducted in MEDLINE (PubMed), Scopus, and PsycINFO from database inception to 15 December 2025 (initial search: 1 December 2023; updated: 15 December 2025). Data were charted using a standardised form. Eligible studies included adolescents, employed EGNG, DDT, or BART, and assessed depressive or anxiety symptoms.

Thirty reports were included (EGNG n = 21; DDT n = 3; BART n = 6). Twenty-six studies (87%) were conducted in high-income countries and 24 (80%) were English language. Twenty-two studies were cross-sectional (EGNG n = 18/21; DDT n = 2/3; BART n = 2/6); five employed longitudinal designs, and two employed experimental manipulations. Fourteen studies (47%) reported significant task performance associations with depression or anxiety (EGNG n = 8/21; DDT n = 2/3; BART n = 4/6); the remaining studies reported no significant associations. The directionality of associations differed across study populations and methodologies.

The current literature is concentrated in English-speaking higher-income contexts and has yielded few and inconsistent associations with adolescent depression and anxiety. Future research should harmonise protocols, expand evidence from low- and middle-income settings, and increase longitudinal and intervention-based studies to assess sensitivity to change and clinical utility.