Receiving a psychiatric diagnosis in childhood or adolescence can have numerous social, emotional and practical repercussions. Among the most important of these are the implications for a young person's self-concept and social identity. To ensure diagnoses are communicated and managed in a way that optimally benefits mental health trajectories, understanding young people's first-hand experience of living with a diagnosis is paramount. This systematic review collates, evaluates and synthesises the qualitative research that has explored how psychiatric diagnosis interacts with young people's self-concept and social identity. A search of 10 electronic databases identified 3892 citations, 38 of which met inclusion criteria. The 38 studies were generally evaluated as moderate-to-high quality research. Thematic synthesis of their findings highlighted the multifaceted ways diagnosis affects young people's self-concept and social identity. Diagnosis can sometimes threaten and devalue young people's self-concept, but can also facilitate self-understanding, self-legitimation and self-enhancement. A diagnosis can lead to social alienation, invalidation and stigmatisation, yet can also promote social identification and acceptance. Further research is needed to clarify which self and identity outcomes can be expected in a given set of circumstances, and to establish how self and identity effects interact with diagnoses' other clinical, practical, social and emotional consequences.

BackgroundPrader–Willi syndrome (PWS) is a neurogenetic syndrome with an associated behavioural phenotype and a high incidence of behaviours of concern and psychiatric co‐morbidity. These associated behaviours and co‐morbidities are not well addressed by existing interventions, and they impact significantly on affected individuals and their caregivers.MethodsWe undertook a national survey of the needs of individuals with PWS and their families in Ireland. In this paper, we report on the parent/caregiver‐reported mental health, behavioural and access to services.ResultsOver 50% of individuals with PWS in this survey had at least one reported psychiatric diagnosis, the most common diagnosis was anxiety. The most commonly reported behaviours in children were skin picking, repetitive questioning, difficulty transitioning and non‐compliance. The same four behaviours were reported by caregivers as being the most commonly occurring in adolescents and adults in addition to food‐seeking behaviours. Increased needs for mental health services were also reported by caregivers. Individuals with PWS had an average wait of 22 months for an appointment with a psychologist and 4 months for an appointment with a psychiatrist.ConclusionThis study highlighted high levels of psychiatric co‐morbidities and behavioural concerns in individuals with PWS in Ireland. The findings of this study suggest that there is an urgent need to provide specialist psychiatric and behavioural interventions to manage complex mental health and behavioural needs to better support individuals with PWS and reduce caregiver burden.

Background Carer burden amongst carers of youth with an eating disorder is substantial and if not addressed can lead to negative outcomes for the patient, carer and family. The Coronavirus Disease 2019 (COVID-19) pandemic has made caring for youth with an ED even more onerous and preliminary research is beginning to emerge demonstrating the profound negative impact the pandemic is having upon individuals with EDs and their carers. Main In this review, we briefly summarize what is known about carer burden in families where a young person has an ED, consider the additional impact consequent to COVID-19 and highlight the need for interventions aimed at alleviating this. Pre-COVID-19 research identifies high levels of psychological and physical strain amongst those caring for a child with an ED. Themes are beginning to emerge as to why COVID-19 may further exacerbate carer burden: (1) reduced access to ED services; (2) increased physical vulnerability and exacerbation of psychiatric co-morbidity amongst youth with EDs; (3) increased practical demands placed on carers; and (4) social isolation and decreased social support. Conclusion The COVID-19 pandemic poses a specific threat to the mental health of youth with EDs and their carers. Given the salient role families play in caring for youth with an ED, attending to carer burden is imperative. Supporting carers through all phases of their child’s ED journey by offering adaptive and flexible supportive services which accommodate time constraints, geographic barriers and possible COVID-19 spread is essential.

Background: Concern has been expressed about an increase in mental illness and eating disorders in particular during the pandemic. Whether Covid-19 associated stress presents a specific risk for eating disorders, new or relapsing, in vulnerable groups remains to be established. Aim: This study explores any impact of Covid-19 on numbers and clinical profile of eating disorder presentations to a Child and Adolescent Mental Health Service (CAMHS) specialist eating disorder treatment program pre and during Covid-19. Methods: Following ethical approval, retrospective data extraction from electronic healthcare records from all referrals to a CAMHS specialist eating disorder treatment program in Dublin, Ireland was conducted. The study period covered 42months, from 1st January 2018 until 31st Aug 2021. Referral rates and clinical characteristics of pre- Covid-19 (January 2018-Feb 2020) and Covid-19 patients (March 2020-Aug 2021) were examined, using Welch’s t- and chi-square tests for continuous and categorical data respectively. Results: 128 youth were assessed over the 42-month study period, with significantly higher rates of referrals post-pandemic (3.78 per month compared to a pre- Covid-19 rate of 2.31/month). (p=.02). Youth referred during Covid-19 lost weight at a faster rate; 2.3kg/month compared to 1.9kg/month pre- Covid-19 (p=.39) and showed a higher rate of % Ideal bodyweight loss (IBW), 4.8% IBW/month compared to 2.6% IBW/month pre- Covid-19 (p=<.001). They also had a shorter duration of illness pre-referral (M=7.4 months, SD=3 pre-Covid-19; M=4.8 months, SD=4.5 post Covid-19, (p<.001), with fewer youth (19%) prescribed psychotropic medication than pre Covid-19 (43%, p=.011). Many youth (80%) self-declared Covid-19 as having had an adverse effect on their overall well-being and as a contributory factor to the development of their eating disordered pathology.Conclusions: This study supports the growing consensus of a Covid-19 specific impact for ED services with higher rates of referrals, youth presenting with a faster pace of IBW% loss and earlier referral to specialist services. Whether this reflects a true and specific increase in EDs or reflects an overall increase in CAMHS referrals, with increased transfer to ED services, needs further examination.