CAPMH Corner (Updated Sep 2026)

Child and Adolescent Psychiatry and Mental Health (CAPMH) is the official IACAPAP Journal. The "CAPMH Corner" of the September 2026 issue of IACAPAP Bulletin summarizes the following three studies recently published in CAPMH – INSPIRE: a pilot cluster randomised feasibility trial of a school-based mental health literacy programme for adolescents and parents in Indonesia (Yani et al., 2026), The Electronic Psychiatric Semi-structured Interview for Children and Adolescents (EPSI-C): development and psychometric evaluation of an open-access DSM-5-based diagnostic instrument (Olofsdotter et al., 2026), and Global prevalence of internet gaming disorder in children and adolescents: a systematic review and meta-analysis (Barboza et al., 2026).

Yani et al. (2026), discuss the need for accessible, family-inclusive approaches to adolescent mental health promotion in Indonesia, where mental health problems are common but stigma, limited counsellor capacity, and inadequate parental involvement can hinder early identification and help-seeking. They highlight mental health literacy (MHL) as an important protective factor encompassing knowledge, attitudes, and help-seeking behaviours, while noting that knowledge-focused school interventions have had limited effects on emotional outcomes. Drawing on the social ecological model, the authors develop the Integrated Network for Student Psychosocial Interventions, Resilience, and Education (INSPIRE), a culturally adapted, school-based programme integrating adolescents, parents, and school counsellors. The pilot study primarily aims to assess the feasibility and acceptability of conducting a future cluster-randomised controlled trial, including recruitment, retention, intervention delivery, attendance, and completeness of outcome data. As a secondary aim, the authors explore preliminary signals of change in adolescent and parental mental health literacy and related outcomes. 

The team conducts a two-centre, two-arm cluster-randomised pilot trial with a pre-test and post-test design in two public junior high schools in West Java, Indonesia, between April and July 2025. Adolescents aged 13–15 years and their parents are recruited, with schools randomly allocated to intervention or control conditions. Of 70 eligible adolescent–parent dyads, 52 (74.3%) participate, with 28 dyads in the control group and 24 in the intervention group. The eight-week INSPIRE programme is facilitated by a trained school counsellor and incorporates psychoeducation, experiential learning, social learning, parent–adolescent joint sessions, home-based activities, and WhatsApp-based parental engagement. The programme operates at individual, interpersonal, and school levels, addressing mental health literacy and resilience while strengthening parent–adolescent communication and embedding mental health promotion within existing school health structures. 

Feasibility findings are favourable. Retention is excellent, with all adolescents and 96% of parents completing follow-up, and outcome data are complete. Attendance is high, at 91% among adolescents and 79% among parents. All planned intervention sessions are delivered by the trained counsellor, although several sessions require rescheduling around public holidays. The authors note that stigma and unfamiliarity with terms such as “mental” and “experiment” create some hesitation during recruitment, while the school counsellor-led model and WhatsApp communication facilitate engagement. The findings therefore support the feasibility and acceptability of delivering the intervention within existing school structures. The preliminary outcome findings suggest potentially beneficial changes, although no formal hypothesis testing is undertaken because of the pilot design. Among adolescents, mental health knowledge increases in the intervention group, with scores rising from a mean of 2.79 at baseline to 4.63 at follow-up, while the broader mental health literacy score increases from a median of 101 to 106. Good mental health behaviours and help-seeking behaviour also show favourable trends compared with the control group. Anxiety symptoms decrease modestly in the intervention group, from a mean of 5.88 to 4.88, whereas depression remains largely unchanged and resilience shows little overall improvement. Among parents, mental health knowledge shows a substantial improvement in the intervention group, increasing from a mean of 3.67 at baseline to 6.82 at follow-up and exceeding the control group at follow-up. Positive changes are also observed in parental attitudes towards mental health and help-seeking, while overall mental health literacy improves in both groups. The authors suggest that the family-inclusive component of INSPIRE may contribute to shared improvements across adolescents and parents and may help foster a more supportive environment for mental health communication. 

The authors highlight the theory-driven, multicomponent design, integration of adolescents, parents and school counsellors, and use of existing school infrastructure as important strengths. However, the study is limited by its very small sample and only two clusters, with one school in each trial arm, meaning that differences between groups may reflect school-level characteristics rather than intervention effects. The short follow-up, reliance on self-reported outcomes, variability in attendance, and concerns regarding the reliability and cultural adaptation of some parental measures further limit interpretation. The newly introduced adolescent mental health literacy instrument also requires further validation. 
The team concludes that INSPIRE is feasible and acceptable in Indonesian school settings, with preliminary signals of improvement in adolescent mental health knowledge, literacy and positive mental health behaviours, and in parental knowledge and attitudes. They recommend a fully powered trial involving a larger number of schools, longer follow-up, culturally optimised measures, objective behavioural indicators, dyadic parent–adolescent analyses, and cost-effectiveness evaluation. 
 

Olofsdotter et al. (2026) describe the development and initial psychometric evaluation of the Electronic Psychiatric Semi-structured Interview for Children and Adolescents (EPSI-C), an open-access, platform-independent diagnostic interview for routine child and adolescent psychiatry (CAP). The authors highlight the limitations of unstructured diagnostic assessment and note that existing standardized interviews may be difficult to implement in routine practice because of time, licensing, and digital platform constraints. The EPSI-C was developed as a flexible, DSM-5-based alternative that can be implemented digitally or on paper without licensing fees. Developed between 2019 and 2021 by a multidisciplinary team in Sweden, the EPSI-C is designed for children and adolescents aged 6–17 years and comprises 21 diagnostic modules and a suicidality risk module (Center for Clinical Research Västmanland, 2025). The authors describe its modular structure as allowing targeted assessment based on clinical indication, while retaining clinical judgment in determining diagnoses. Administration typically takes 30–90 minutes, depending on case complexity and the modules required. 

The authors set out to evaluate two foundational psychometric properties: content validity and internal consistency. Content validity was assessed by an independent panel of 10 clinicians from two Swedish CAP clinics, comprising six psychologists, three child and adolescent psychiatrists, and one psychiatric nurse specialist. The experts had a mean of 9.6 years of CAP experience and independently rated the relevance of the screening and full sections of each module on a four-point scale. Internal consistency was examined using data from 3,506 consecutive patients assessed through routine outpatient CAP services in Västmanland County between November 2021 and December 2024. The cohort had a mean age of 12.0 years, 54.5% were girls, and assessments were conducted as part of routine clinical care. 

The team reports that EPSI-C showed excellent content validity, with S-CVI/Ave values of 0.95 for screening sections and 0.94 for full modules. All modules met the excellent validity threshold, except anorexia nervosa, which showed acceptable validity (I-CVI = 0.70). Expert ratings were highly favourable for relevance, coverage, structure, usability, and clinical credibility, with 90% rating clarity as high or very high. Internal consistency was acceptable to excellent in 14 of 16 modules (87.5%), with Cronbach’s α ranging from 0.71 to 0.90. The ADHD module showed the highest internal consistency (α = 0.90), while lower values were observed for anorexia nervosa (α = 0.49) and psychotic disorders (α = 0.53). The authors attribute these lower estimates to the limited number of diagnostic criteria for anorexia nervosa and restricted symptom variability in the stepped-care sample. 

The authors highlight the combination of independent expert evaluation and a large, naturalistic clinical cohort as a key strength, along with expert representation across professional groups and sites and digitally supported data capture. They note limitations including the absence of formal criterion validity testing, small samples for several low-prevalence disorders, and internal consistency analyses restricted to patients who screened positive. Preliminary inter-rater reliability was based on only 15 interviews and, the authors note, requires confirmation in larger and more diagnostically diverse samples. They conclude that the EPSI-C provides a standardized yet clinically flexible approach to DSM-5-based diagnostic assessment in routine CAP practice. Its open-access, platform-independent design and compatibility with local digital systems may help overcome financial, technical, and legal barriers that have limited the uptake of standardized interviews. Further research is needed to establish criterion validity, evaluate effectiveness and acceptability in routine services, examine whether standardized assessment reduces subsequent diagnostic changes, and assess cross-cultural applicability beyond Sweden. 
 

Barboza et al. (2026) examine the global prevalence of Internet Gaming Disorder (IGD) among children and adolescents, noting that previous estimates have varied substantially because of differences in diagnostic criteria, assessment tools, sampling methods, and geographical settings. They highlight that although IGD is recognised in DSM-5 as a condition warranting further study and is included in ICD-11 as a behavioural addiction, epidemiological estimates in young people remain inconsistent. The authors therefore aim to provide an updated global estimate restricted to children and adolescents aged 6–18 years, while exploring variations across geographical regions and diagnostic approaches. 

The team conducts a systematic review and meta-analysis following PRISMA 2020 guidelines and prospective registration in PROSPERO (CRD420251156483). Searches of PubMed, Scopus, Web of Science, Embase, and PsycINFO were conducted up to September 2025. Eligible observational studies included children and adolescents aged 6–18 years and used standardized instruments aligned with DSM-5 or ICD-11 criteria. Two reviewers independently screened studies and extracted data. A random-effects model was used to pool prevalence estimates, with between-study heterogeneity assessed using the I² statistic and publication bias examined using funnel plot asymmetry and Egger’s regression test. 

Nineteen studies comprising 251,037 participants and 26,868 cases of IGD met the inclusion criteria. The pooled global prevalence was 10% (95% CI 6–15%), indicating that approximately one in ten children and adolescents met criteria for IGD. Individual estimates varied considerably, ranging from approximately 1% in some European populations to more than 25% in studies from the Middle East and Latin America. The authors report extreme between-study heterogeneity (I² = 99.7%), with smaller studies tending to report higher prevalence estimates. 

The authors note considerable variation in the assessment of IGD, with the IGDS9-SF being the most frequently used instrument and most studies relying on DSM-5-based definitions. Sampling was predominantly school-based, with methods ranging from convenience to cluster sampling. They emphasise that the pooled prevalence should not be interpreted as a universal global rate and suggest that differences in diagnostic approaches, sampling strategies, and sociocultural and contextual factors may account for much of the observed variation. Although the estimate is higher than those reported in earlier meta-analyses, the authors caution that this may reflect methodological and geographical differences, as well as increased digital engagement after 2020, rather than a true increase in prevalence. They highlight the review’s focus on recent evidence in children and adolescents and its use of DSM-5/ICD-11-aligned measures as strengths, while noting that the predominance of cross-sectional studies limits conclusions about the developmental trajectory of IGD. 

The authors conclude that IGD represents a substantial global mental health concern among children and adolescents. They call for greater standardisation of diagnostic approaches, culturally sensitive preventive strategies, early identification, and further longitudinal research to clarify the course of IGD. They also highlight the potential value of school-based screening, digital literacy, healthy digital behaviours, and parental engagement in prevention and early intervention. 
 

REFERENCES:  

• Barboza, J.J., Bonilla Asalde, C., Rivera-Lozada, O. et al. Global prevalence of internet gaming disorder in children and adolescents: a systematic review and meta-analysis.Child Adolesc Psychiatry Ment Health 20, 90 (2026). https://doi.org/10.1186/s13034-026-01083-8. 
• Center for Clinical Research Västmanland. The Electronic Psychiatric Semi-structured Interview for Children and Adolescents (EPSI-C) [Internet]. 2025 [cited 2025 Dec 8]. Available from: https://regionvastmanland.se/vardgivare/forskning-och-utbildning/forskning/salve/.  
• Olofsdotter, S., Dragou, M., Isaksson, J. et al. The Electronic Psychiatric Semi-structured Interview for Children and Adolescents (EPSI-C): development and psychometric evaluation of an open-access DSM-5-based diagnostic instrument. Child Adolesc Psychiatry Ment Health 20, 67 (2026). https://doi.org/10.1186/s13034-026-01094-5. 
• Yani, D.I., Peng, T.A., Wong, H.C. et al. INSPIRE: a pilot cluster randomised feasibility trial of a school-based mental health literacy programme for adolescents and parents in Indonesia. Child Adolesc Psychiatry Ment Health (2026). https://doi.org/10.1186/s13034-026-01085-6. 
   

IACAPAP Bulletin, Issue 83