The impact of school-closings on adolescents’ mental health and well-being in the management of the ongoing COVID-19 pandemic is subject to ongoing public debate. Reliable data to inform a balanced discussion are limited. Drawing on a large ongoing multi-site project in Germany, we assessed differences in self-reported psychopathology in a matched convenience-sample of adolescents assessed pre- (November 26, 2018 to March 13, 2020; n = 324) and post the first lockdown (March 18, 2020 to August 29, 2020; n = 324) early 2020 in Germany. We found no evidence for an increase in emotional and behavioral problems, depression, thoughts of suicide or suicide attempts, eating disorder symptoms, or a decrease in general health-related quality of life. Reported suicide plans significantly decreased from 6.14 to 2.16%. Similarly, conduct problems decreased in the post-lockdown period. Family risk-factors did not moderate these findings. The influence of socioeconomic status on emotional and behavioral problems as well as depression decreased during the lockdown. Based on the present findings, the first school-closing in Germany had no immediate and severe impact on adolescents’ well-being. However, caution is warranted as our data covers a fairly small, affluent sample over a limited time-span and long-term consequences cannot be ruled out.

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Background: A large body of scientific literature derived from experimental studies emphasizes the vital role of vagal-nociceptive networks in acute pain processing. However, research on vagal activity, indexed by vagally-mediated heart rate variability (vmHRV) in chronic pain patients (CPPs), has not yet been summarized. Objectives: To systematically investigate differences in vagus nerve activity indexed by timeand frequency-domain measures of vmHRV in CPPs compared to healthy controls (HCs). Study Design: A systematic review and meta-analysis, including meta-regression on a variety of populations (i.e., clinical etiology) and study-level (i.e., length of HRV recording) covariates. Setting: Not applicable (variety of studies included in the meta-analysis) Methods: Eight computerized databases (PubMed via MEDLINE, PsycNET, PsycINFO, Embase, CINAHL, Web of Science, PSYNDEX, and the Cochrane Library) in addition to a hand search were systematically screened for eligible studies based on pre-defined inclusion criteria. A metaanalysis on all empirical investigations reporting short- and long-term recordings of continuous time- (root-mean-square of successive R-R-interval differences [RMSSD]) and frequency-domain measures (high-frequency [HF] HRV) of vmHRV in CPPs and HCs was performed. True effect estimates as adjusted standardized mean differences (SMD; Hedges g) combined with inverse variance weights using a random effects model were computed. Results: CPPs show lower vmHRV than HCs indexed by RMSSD (Z = 5.47, P < .0001; g = -0.24;95% CI [-0.33, -0.16]; k = 25) and HF (Z = 4.54, P < .0001; g = -0.30; 95% CI [-0.44, -0.17]; k = 61).Meta-regression on covariates revealed significant differences by clinical etiology, age, gender, and length of HRV recording. Limitations: We did not control for other potential covariates (i.e., duration of chronic pain, medication intake) which may carry potential risk of bias. Conclusion(s): The present meta-analysis is the most extensive review of the current evidence on vagal activity indexed by vmHRV in CPPs. CPPs were shown to have lower vagal activity, indexed by vmHRV, compared to HCs. Several covariates in this relationship have been identified. Further research is needed to investigate vagal activity in CPPs, in particular prospective and longitudinal follow-up studies are encouraged. Key words: Vagus nerve, heart rate variability, chronic pain, irritable bowel syndrome, fibromyalgia, primary headache disorders, meta-analysis, systematic review

Borderline personality disorder (BPD) is among the most severe mental health problems with long-lasting deterioration of functioning. According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the noninferiority of adolescent identity treatment (AIT) compared with dialectical behavior therapy for adolescents (DBT-A), and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescent patients. In a nonrandomized controlled trial using a noninferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT. Both treatments included 25 weekly individual psychotherapy sessions and five to eight family sessions. Patients were assessed at four timepoints: baseline, posttreatment, 1-and 2-year follow-up. Primary outcome was psychosocial functioning at 1-year follow-up. We performed both intention-to-treat analyses and per-protocol analyses (completers). Baseline characteristics of both groups were not significantly different except for age and self-injurious behavior. In all, six AIT patients (26%) and 10 DBT-A patients (27%) dropped out of treatment. Both DBT-A and AIT significantly improved adolescents' psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A and even more efficient in reducing BPD criteria. Both treatments are highly effective in improving psychosocial functioning and personality functioning in adolescent BPD patients. AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency.

The purpose of this systematic review of international research is to summarize the available literature on active music making interventions with adult offenders in forensic settings (i.e. forensic psychiatry or correctional facilities at different security levels). A systematic search of 13 electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) statement was employed. 28 articles fitting the inclusion criteria were included in the review. The search revealed mainly qualitative and narrative reports including articles on group music therapy, educational music making, choir interventions, individual music therapy sessions and musical projects. The musical interventions are described in detail to provide therapists with ideas on how to set up session with clients who may be in this particular situation and to help them understand the possible impact of musical interventions in the forensic setting. Furthermore, implications from the current evidence and ideas for future research are discussed. Note: Due to the length of the review it is published in two subsequent issues. This is the second part of the review focusing on case studies and the Good Vibrations program. The first part of the review was published in the previous issue of Music and Medicine focusing on group interventions.

Impairments in both stress regulation and emotion recognition have been associated with borderline personality disorder (BPD) and non-suicidal self-injury (NSSI). Although it has been proposed that emotion recognition deficits particularly emerge during stress, this hypothesis has not been fully investigated. Adolescents with and without NSSI performed emotion recognition tasks before and after the employment of the Trier Social Stress Test (TSST). The psychobiological stress response was captured with psychological self-reports (affect, stress and dissociation), physiological recordings (heart rate, HR, and heart rate variability, HRV) and endocrinological sampling of saliva (cortisol and alpha-amylase). Mixed-linear models were applied to analyze stress-induced changes in emotion recognition performance and respective stress response measures. The TSST elicited altered psychobiological stress responses in adolescents with NSSI: A more pronounced decrease in positive affect, a more pronounced increase in negative affect, a less pronounced increase in HR, a less pronounced decrease in HRV and a more pronounced increase in alpha-amylase throughout the stress induction than adolescents without NSSI. Stress responses (dissociation, negative affect, cortisol and HR) differed as a function of BPD severity on a continuum, illustrating greater reactivity on self-reports but decreased biological responsiveness in those with greater BPD severity. Stress induction had similar effects on emotion recognition in adolescents with and without NSSI. Recognition sensitivity and recognition speed equally increased, in the absence of any differences in recognition accuracy. In contrast to prominent propositions, psychosocial stress does not appear to account for impaired emotion recognition across the BPD spectrum.

Research has established the diagnostic validity of borderline personality disorder (BPD) in adolescence. The roots of BPD often lie in childhood; however, significantly less is known about the presence and correlates of BPD traits in school-age children and whether these are comparable with those observed in adolescents. Trained psychologists administered the Childhood Interview for Borderline Personality Disorder in a cohort of 14-year-old adolescents (n = 76) and a cohort of 9-year-old children (n = 70). We compared the prevalence of BPD traits in both cohorts and investigated common psychosocial correlates (comorbidity, impaired quality of life, emotional/behavioral problems, maternal distress, and observed mother–child interaction). Children and adolescents showed no significant differences regarding the type and frequency of BPD traits. In both cohorts, BPD traits were associated with comorbidity, emotional and behavioral problems, and lower quality of life. In contrast to adolescents, children’s BPD traits were not significantly related to maternal distress and showed less relations to interaction patterns. Negative maternal and dyadic behavior were associated with more BPD traits in adolescents during a conflict discussion but not during fun day planning. Our study suggests that BPD traits in children are similarly frequent as in adolescents and accompanied by psychosocial impairment. However, age-related differences were revealed, mostly indicating weaker associations with the mother–child relationship. Mother–child interaction patterns in youth seem to be especially relevant during conflict discussion and provide a target for intervention. Our study provides preliminary support for potential early detection of BPD pathology among children and encourages further study of its life span perspective.

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