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Laestadius LI, Craig KA, Campos-Castillo C. Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis. J Med Internet Res 2021; 23:e28931. [PMID: 34383683 PMCID: PMC8386397 DOI: 10.2196/28931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. OBJECTIVE The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. METHODS We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. RESULTS Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. CONCLUSIONS Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care.
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Affiliation(s)
- Linnea I Laestadius
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Katherine A Craig
- Department of Sociology, University of Colorado Boulder, Boulder, CO, United States
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102
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Li BCM, Wright B, Black T, Newton AS, Doan Q. Utility of MyHEARTSMAP in Youth Presenting to the Emergency Department with Mental Health Concerns. J Pediatr 2021; 235:124-129. [PMID: 33819465 DOI: 10.1016/j.jpeds.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the utility of a digital psychological self-assessment tool, MyHEARTSMAP (scores on 10 sections: home, education and activities, alcohol and drugs, relationships and bullying, thoughts and anxiety, safety, sexual health, mood, abuse, and professional resources), in youth presenting to the pediatric emergency department (ED) with a mental health concern. STUDY DESIGN We conducted a prospective cohort study in 2 tertiary care pediatric EDs from December 2017 to October 2019. Youth 10-17 years old triaged for a mental health concern were screened and enrolled to complete MyHEARTSMAP on a mobile device. A clinician blinded to the MyHEARTSMAP assessment conducted their own assessment which was used as the reference standard. Utility was quantified as the sensitivity and specificity of MyHEARTSMAP in detecting psychiatric, social, youth health, and functional concerns. RESULTS Among 379 eligible youth, 351 were approached and 233 (66.4%) families were enrolled. Sensitivity for youth MyHEARTSMAP self-assessments ranged from 87.4% in the youth health domain to 99.5% in the psychiatric domain for identifying any concern, and 33.3% in the social domain to 74.6% in the psychiatric domain for severe concerns. Specificity ranged from 66.7% in the psychiatric domain to 98.2% in the youth health domain for no or only mild concerns. CONCLUSIONS Youth and guardian MyHEARTSMAP assessments are sensitive for detecting psychosocial concerns requiring follow-up beyond pediatric ED evaluation. Specificity for no or only mild concerns was high in the nonpsychiatric domains.
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Affiliation(s)
- Brian C M Li
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda S Newton
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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103
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Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders. Ann Emerg Med 2021; 78:628-636. [PMID: 34218952 DOI: 10.1016/j.annemergmed.2021.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. METHODS We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. RESULTS Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. CONCLUSION Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.
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104
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Nickerson AB, Breux P, Schaffer GE, Samet M. An Initial Evaluation of the Helping Students at Risk for Suicide Professional Development Workshop. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1919494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Pat Breux
- Suicide Prevention Center of New York
| | | | - Mitch Samet
- New York Association of School Psychologists
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105
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Abstract
The top 5 reasons for pediatric malpractice are cardiac or cardiorespiratory arrest, appendicitis, disorder of male genital organs, encephalopathy, and meningitis. Malpractice is most likely to result from an "error in diagnosis." Claims involving a "major permanent injury" were more likely to pay out money, but of all claims, only 30% result in a monetary pay out. Consideration of "high-risk misses" may help to direct a history, examination, testing, and discharge instructions.
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106
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Nash KA, Zima BT, Rothenberg C, Hoffmann J, Moreno C, Rosenthal MS, Venkatesh A. Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015). Pediatrics 2021; 147:peds.2020-030692. [PMID: 33820850 PMCID: PMC8086002 DOI: 10.1542/peds.2020-030692] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
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Affiliation(s)
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | | | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Claudia Moreno
- Yale Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Arjun Venkatesh
- Emergency Medicine, and,Center for Outcomes Research & Evaluation, New Haven, Connecticut
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107
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Masciale M, Dongarwar D, Salihu HM. Predictors of Prolonged Length of Stay in Suicidal Children Transferred to Psychiatric Facilities. Hosp Pediatr 2021; 11:366-373. [PMID: 33782014 DOI: 10.1542/hpeds.2020-001230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS. METHODS For this retrospective cross-sectional study, we used the National Inpatient Sample. We included children <18 years old hospitalized with a primary or secondary International Classification of Diseases, 10th Edition, Clinical Modification diagnosis of SI or SA who were dispositioned to psychiatric facilities from 2016 to 2017. Exposures were patient sociodemographics, underlying mental health diagnoses, and hospital characteristics. Our outcome was pLOS. Adjusted prevalence ratios with 95% confidence intervals (CIs) were generated with log binomial regression. RESULTS Of 12 715 hospitalizations meeting inclusion criteria, 5475 had pLOS. After adjusting for sociodemographics and hospital characteristics, predictive factors for pLOS were public insurance use (prevalence ratio: 1.40; CI: 1.12-1.78), urban nonteaching hospital location (prevalence ratio: 4.61; CI: 2.33-9.12), urban teaching hospital location (prevalence ratio: 3.26; CI: 1.84-5.76), and underlying diagnosis of mood disorder (prevalence ratio: 1.98; CI: 1.63-3.42). Hispanic patients had decreased probability of pLOS (prevalence ratio: 0.69; CI: 0.52-0.93). Otherwise, age, zip income, sex, and hospital region were not predictive of pLOS. CONCLUSIONS Among children hospitalized for SI or SA requiring transfer to psychiatric facilities, public insurance, urban hospital location, and diagnoses of mood disorder, depression, and bipolar disorder were predictive of pLOS. Further research is needed on how to decrease disparities in length of stay among this vulnerable population.
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Affiliation(s)
- Marina Masciale
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
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108
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Sellers CM, Díaz-Valdés A, Oliver MM, Simon KM, O'Brien KHM. The relationship between alcohol and cannabis use with nonsuicidal self-injury among adolescent inpatients: Examining the 90 days prior to psychiatric hospitalization. Addict Behav 2021; 114:106759. [PMID: 33338906 DOI: 10.1016/j.addbeh.2020.106759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study examined the trajectories of alcohol use, cannabis use, suicide planning (SP), and nonsuicidal self-injury (NSSI) prior to hospitalization and examined the role of alcohol and cannabis use, independently and jointly, in predicting NSSI on a daily level and over time. METHODS Participants included 71 adolescents hospitalized for suicide risk (75% female; 25% male; Mage = 15.79). All participants drank alcohol at least once in the prior 90-days. We conducted mixed effect models to assess the trajectories of alcohol use, cannabis use, and NSSI over the 90-days prior hospitalization. To test the effect of SP, alcohol use, and cannabis use on NSSI, we conducted logistic random effect models, while controlling for demographics. RESULTS SP (OR = 4.47, p < 0.001) and suicide ideation (SI) (OR = 10.09, p < 0.001) significantly increased the odds of engaging in NSSI. Neither cannabis nor alcohol use independently predicted the odds of engaging in NSSI, however, the co-occurrence of alcohol and cannabis use increased the odds of engaging in NSSI on a given day (OR = 30.5, p < 0.05). CONCLUSIONS Study findings extend current knowledge about the longitudinal and day-to-day relationships between alcohol and cannabis use and NSSI. Results underscore the importance of developing interventions that address polysubstance use among suicidal adolescents engaging in NSSI.
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109
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Glomb NW, Grupp-Phelan J. A Call to Action to Address Disparities in Pediatric Mental Health Care. Pediatrics 2020; 146:peds.2020-018911. [PMID: 32963022 DOI: 10.1542/peds.2020-018911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicolaus W Glomb
- Department of Emergency Medicine, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
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110
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McBride DL. Emergency Department Preparedness for Children Seeking Mental Health Care. J Pediatr Nurs 2020; 54:106-108. [PMID: 32736840 PMCID: PMC7386204 DOI: 10.1016/j.pedn.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 11/20/2022]
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111
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Holmberg M, Hammarbäck S, Andersson H. Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/2057158520941753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.
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Affiliation(s)
- Mats Holmberg
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Staffan Hammarbäck
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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112
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Thiessen M, Cui Q, Hu XJ, Rosychuk RJ. Exploring spatio-temporal patterns in mental health related emergency department use from children and adolescents. Spat Spatiotemporal Epidemiol 2020; 34:100358. [PMID: 32807398 DOI: 10.1016/j.sste.2020.100358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
To understand the spatio-temporal patterns and associated risk factors with the frequency, we analyze records of mental health related emergency department (MHED) visits from youth. The data are extracted for the period 2002--2011 from the population-based, provincial health administrative data systems of Alberta, Canada. Guided by a descriptive analysis, we conduct generalized linear regression analyses of the counts of MHED visits from various health areas. Seasonal effects are examined via three different types of functions, including trigonometric functions. We specify the temporal correlation using an autoregressive model of order 1 and formulate the spatial correlation by a random effects model. Our analysis reveals a strong seasonal pattern and indicates that the MHED visit counts are significantly associated with age, gender, and a proxy for socio-economic status. The final statistical model may be used to forecast future MHED use and identify regions and groups at a higher risk to the MHEDs.
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Affiliation(s)
- Michelle Thiessen
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada; Winnipeg, Manitoba, Canada
| | - Qi Cui
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - X Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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113
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Hoffmann JA, Foster AA. Ready or Not, Here I Come: Emergency Department Readiness for Pediatric Mental Health Visits. Pediatrics 2020; 145:peds.2019-3542. [PMID: 32393607 DOI: 10.1542/peds.2019-3542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; .,Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Ashley A Foster
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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