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Martin A. Editorial: Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024; 63:863-864. [PMID: 38280413 DOI: 10.1016/j.jaac.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
Rates of death by suicide, suicidal gestures, suicide attempts, and nonsuicidal self-injury among adolescents have increased over the past decade.1 Despite these sobering trends, the availability of appropriate clinical services has not kept pace with the growing need. A shortage of inpatient psychiatric beds for children and adolescents is among the shortcomings of today's US mental health system of care.
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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024; 63:908-918. [PMID: 38280417 DOI: 10.1016/j.jaac.2023.09.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population. METHOD This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA. RESULTS Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85). PLAIN LANGUAGE SUMMARY This study utilized retrospective data from the National Inpatient Sample (2015 to 2019) to determine predictive factors for discharge against medical advice (DAMA) for youth, aged 10 to 19 years old, hospitalized for suicidal ideation or suicide attempt. Of 476,755 hospitalizations for suicidality, 3,825 (0.8%) were discharged against medical advice. Correlates of discharge against medical advice included age 16 to 19 years, self-pay status, admission to an urban non-teaching hospital, or a hospital located in the South or West Regions of the United States. Hispanic patients were less likely to be discharged against medical advice with no other racial/ ethnic differences observed. CONCLUSION Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
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Mojtabai R, Olfson M. Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01357-1. [PMID: 39214290 DOI: 10.1016/j.jaac.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/29/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States. METHOD Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client Level Data (MH-CLD) 2013-2021 (total number of records=13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic and service strata focusing on community-based programs. RESULTS The analyses revealed increases in the proportion with anxiety disorders from 9.6% in 2013 to 19.2% in 2021, AOR=2.17, 95% CI=1.85-2.55, p<0.001, trauma- and stressor-related disorders from 22.7% to 27.4%, AOR=1.31, 1.09-1.57, p=0.004, and depressive disorders from 13.4% to 17.0%, AOR=1.20, 1.03-1.41, p=0.04. During this same period, the proportion with bipolar disorders declined almost eight-fold from 10.0% to 1.3%; AOR=0.07, 0.06-0.09, p<0.001. The proportion with conduct disorders also declined from 9.7% to 4.4%; AOR=0.42, 0.32-0.55, p<0.001, and the proportion of oppositional-defiant disorder declined from 11.1% to 7.8%; AOR=0.79, 0.65-0.98, p=0.03. Trends varied across sex, age, and racial/ethnic strata. CONCLUSION The composition of childhood psychiatric diagnoses in patients within publicly funded mental health settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.
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Affiliation(s)
- Ramin Mojtabai
- Tulane University School of Medicine, New Orleans, Louisiana.
| | - Mark Olfson
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York
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Racine N, Pitt T, Premji S, McDonald SW, Patten SB, Tough S, Madigan S. Prevalence of Common Child Mental Health Disorders Using Administrative Health Data and Parent Report in a Prospective Community-Based Cohort from Alberta, Canada: Prévalence des troubles communs de santé mentale de l'enfant à l'aide des données de santé administratives et des rapports des parents dans une cohorte prospective communautaire d'Alberta, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241271708. [PMID: 39169746 DOI: 10.1177/07067437241271708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. METHODS Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data"). RESULTS Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources. CONCLUSIONS The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood.Plain Language Title: Prevalence of child mental health disorders according to different data sources in Canada.
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Affiliation(s)
- N Racine
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - T Pitt
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S Premji
- Centre for Health Economics, University of York, Heslington, York, UK
| | - S W McDonald
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - S B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Peter Lougheed Hospital, Calgary, Alberta, Canada
| | - S Tough
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - S Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Davico C, Marcotulli D, Abbracciavento G, Anfosso T, Apicella M, Averna R, Bazzoni M, Calderoni D, Cammisa L, Carta A, Carucci S, Cozzi G, Di Santo F, Fazzi E, Lux C, Narducci C, Nobili L, Onida I, Pisano T, Raucci U, Sforzi I, Siri L, Sotgiu S, Tavano S, Terrinoni A, Uccella S, Vicari S, Zanus C, Vitiello B. COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents. JAMA Netw Open 2024; 7:e2425829. [PMID: 39102265 DOI: 10.1001/jamanetworkopen.2024.25829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Importance There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive. Objective To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak. Design, Setting, and Participants A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023. Exposure The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity. Main Outcomes and Measures Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis. Results A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10). Conclusions and Relevance In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.
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Affiliation(s)
- Chiara Davico
- Department of Public Health and Pediatric Sciences, University of Turin/Regina Margherita Children's Hospital, Turin, Italy
| | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, University of Turin/Regina Margherita Children's Hospital, Turin, Italy
| | | | - Thomas Anfosso
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Massimo Apicella
- Division of Child and Adolescent Psychiatry, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Roberto Averna
- Division of Child and Adolescent Psychiatry, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marzia Bazzoni
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Dario Calderoni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Cammisa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Carta
- University Hospital of Sassari, Division of Child Neuropsychiatry, Sassari, Italy
| | - Sara Carucci
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, "A. Cao" Paediatric Hospital, ASL Cagliari, Italy
| | - Giorgio Cozzi
- University of Trieste, B. Garofalo Hospital, Trieste, Italy
| | - Federica Di Santo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Caterina Lux
- Department of Public Health and Pediatric Sciences, University of Turin/Regina Margherita Children's Hospital, Turin, Italy
| | - Chiara Narducci
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, "A. Cao" Paediatric Hospital, ASL Cagliari, Italy
| | - Lino Nobili
- IRCCS Istituto G. Gaslini, University of Genoa, Genoa, Italy
- IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Ilaria Onida
- University Hospital of Sassari, Division of Child Neuropsychiatry, Sassari, Italy
| | - Tiziana Pisano
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Umberto Raucci
- Division of Child and Adolescent Psychiatry, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Idanna Sforzi
- Emergency Department and Trauma Center Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Stefano Sotgiu
- University Hospital of Sassari, Division of Child Neuropsychiatry, Sassari, Italy
| | - Simone Tavano
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Arianna Terrinoni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Sara Uccella
- IRCCS Istituto G. Gaslini, University of Genoa, Genoa, Italy
- IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Stefano Vicari
- Division of Child and Adolescent Psychiatry, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Catholic University, Rome, Italy
| | - Caterina Zanus
- University of Trieste, B. Garofalo Hospital, Trieste, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Turin/Regina Margherita Children's Hospital, Turin, Italy
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Dean AL, Lambrese JV. Treating Children and Adolescents with Aggressive Behaviors in the Inpatient Setting. Pediatr Ann 2024; 53:e293-e298. [PMID: 39120453 DOI: 10.3928/19382359-20240605-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
The mental health crisis in children and adolescents presents a unique challenge for pediatric providers in the inpatient setting. Patients are presenting to the emergency department in acute psychiatric crises, but the increased need for behavioral health services is met with an already limited supply of behavioral health services and facilities. As such, these patients are hospitalized on acute care floors, which can serve to exacerbate symptoms of aggression regardless of cause and complicates treatment and harm prevention strategies. We present a comprehensive management approach to the acutely agitated pediatric patient with aggressive behaviors, including prevention of symptoms in patients with risk factors; nonpharmacological approaches to de-escalation, including the use of restraint; and common oral and parenteral psychopharmacological agents. Such strategies are considered from a medical, ethical, and legal standpoint with the goal of maintaining safety and minimizing harm to patients, families, and staff. [Pediatr Ann. 2024;53(8):e293-e298.].
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Goldstein TR, Kennard BD, Porta G, Miller AO, Aguilar K, Bigley K, Vaughn-Coaxum RA, McMakin DL, Douaihy A, Iyengar S, Biernesser CL, Zelazny J, Brent DA. Bridging Gaps in Care Following Hospitalization for Suicidal Adolescents: As Safe As Possible (ASAP) and BRITE App. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00361-7. [PMID: 39032815 DOI: 10.1016/j.jaac.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/10/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE We present results from a 2-site, randomized clinical trial to assess the efficacy of a brief intervention (As Safe As Possible [ASAP]), a safety plan phone application (BRITE), and their combination on suicide attempts, suicidal ideation, non-suicidal self-injury, re-hospitalizations. and suicidal events among adolescents. METHOD Adolescents (n= 240; 12-17 years of age) who were hospitalized for suicidal ideation with plan and/or intent, and/or suicide attempt, were assigned to 1 of 4 treatment conditions in a 2 by 2 design: ASAP+BRITE app+treatment as usual (TAU); (2) BRITE+TAU; (3) ASAP+TAU; and (4) TAU alone. Independent evaluators assessed suicidal ideation and behavior at 4, 12, and 24 weeks using the Columbia-Suicide Severity Rating Scale (C-SSRS) and re-hospitalization using the Child and Adolescent Services Assessment (CASA). RESULTS No group differences were found on primary outcomes, except that ASAP participants were less likely to be re-hospitalized over 6 months (15.6%, vs 26.5%, p = .046). Participants hospitalized for an attempt and assigned to BRITE had a lower rate of subsequent attempts (odds ratio [OR] = 0.16, p = .01) and a greater time to attempt (hazard ratio [HR] = 0.20, p = .02). ASAP+BRITE, albeit not statistically significant, was most consistently associated with a reduction (60% reduction) in suicide attempts. CONCLUSION ASAP, BRITE, and their combination are equally effective at decreasing risk for suicidal events 6 months post hospital discharge among suicidal adolescents; the ASAP intervention (with or without BRITE) was associated with lower rates of re-hospitalization. The BRITE app in youth hospitalized for suicide attempt had promising outcomes in regard to future attempts. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. The research was performed with permission from the University of Pittsburgh Institutional Review Board and the University of Texas Institutional Review Board. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. CLINICAL TRIALS REGISTRATION INFORMATION Establishing Efficacy of an Inpatient Intervention and Phone App to Reduce Suicidal Risk (ASAP+BRITE); https://clinicaltrials.gov/study/; NCT03825588.
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Affiliation(s)
| | - Betsy D Kennard
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Karen Aguilar
- University of Texas Southwestern Medical Center, Dallas, Texas
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Shields RJ, Helfrich JP, Gregory RJ. Dynamic Deconstructive Psychotherapy for Suicidal Adolescents: Effectiveness of Routine Care in an Outpatient Clinic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:929. [PMID: 39063505 PMCID: PMC11276631 DOI: 10.3390/ijerph21070929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
Suicidal behavior and demand for services have been increasing in adolescents. Many of the current treatments are focused on symptom mitigation, crisis management, and safety planning; however, few are aimed at remediating underlying vulnerabilities that may be contributing to suicide risk. Dynamic Deconstructive Psychotherapy (DDP) has been found to be effective for suicidal adults but has never been studied for adolescents. The present study examined real-world outcomes of 65 suicidal adolescents, aged 13-17 years, receiving weekly DDP in an outpatient clinic. The primary outcome was change in suicide ideation from baseline to 6 months of treatment as assessed by the Suicide Ideation Subscale of the Columbia Suicide Severity Rating Scale. In intent-to-treat analyses, suicide ideation significantly decreased over the 6 months with a large treatment effect (d = 1.19). Secondary measures, such as suicide attempts, self-harm, depression, anxiety, disability, self-compassion, and inpatient utilization, also improved significantly. Among the 42 adolescents (65%) who completed at least 6 months of treatment, suicide attempts decreased by 84%. DDP may be effective in reducing suicide ideation and other risk factors in suicidal adolescents and may be cost-effective given reduced inpatient utilization. These initial promising findings warrant further research and development.
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Affiliation(s)
| | | | - Robert J. Gregory
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA; (R.J.S.); (J.P.H.)
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Sanders N, Abela KM, Davenport L, Lawrence J, Gibbs K, Hess LM. Improving clinician agreement and comfort through the development of a pediatric behavioral health huddle tool. J Pediatr Nurs 2024; 77:e327-e334. [PMID: 38719705 DOI: 10.1016/j.pedn.2024.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/15/2023] [Accepted: 04/26/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Hospitalized pediatric patients with behavioral health (BH) diagnoses awaiting transfer can exhibit behaviors that may lead to workplace violence such as aggression. Workplace violence can lead to discomfort in caring for these patients. Huddles can be used as a tool to identify potential for violence, to help address workplace violence, and improve clinician situational awareness. METHODS Utilizing QI methodology, a BH specific huddle tool was created and implemented on an Acute Care floor that identified key components such as triggers and behavioral stability. Mixed methods were used to study the intervention including focus groups, surveys and measurement of agreement (surrogate for situational awareness). The aims of this quality improvement (QI) project were to 1) improve situational awareness by increasing agreement between team members 2) improve the overall comfort of the clinical team caring for BH patients by 10%. RESULTS Agreement between clinicians on patient stability increased by 20%. Comfort in caring for BH patients increased by 4%. Providers reported the tool increased their understanding (89%) and communication (81%) regarding plan of care. APPLICATION TO PRACTICE Standardized huddle tool can be utilized to increase situational awareness among team members caring for patients with behavioral health diagnoses and may help to address workplace violence.
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Affiliation(s)
| | - Karla M Abela
- Baylor College of Medicine, United States of America
| | | | | | - Karen Gibbs
- Texas Children's Hospital, United States of America; Baylor College of Medicine, United States of America
| | - Lauren M Hess
- Texas Children's Hospital, United States of America; Baylor College of Medicine, United States of America.
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10
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Wells J, Shah A, Gillis H, Gustafson S, Powell C, Krasaelap A, Hanna S, Hoefert JA, Bigelow A, Sherwin J, Lewis EC, Bline KE. Tiny patients, huge impact: a call to action. Front Public Health 2024; 12:1423736. [PMID: 38952729 PMCID: PMC11215126 DOI: 10.3389/fpubh.2024.1423736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
The continuation of high-quality care is under threat for the over 70 million children in the United States. Inequities between Medicaid and Medicare payments and the current procedural-based reimbursement model have resulted in the undervaluing of pediatric medical care and lack of prioritization of children's health by institutions. The number of pediatricians, including pediatric subspecialists, and pediatric healthcare centers are declining due to mounting financial obstacles and this crucial healthcare supply is no longer able to keep up with demand. The reasons contributing to these inequities are clear and rational: Medicaid has significantly lower rates of reimbursement compared to Medicare, yet Medicaid covers almost half of children in the United States and creates the natural incentive for medical institutions to prioritize the care of adults. Additionally, certain aspects of children's healthcare are unique from adults and are not adequately covered in the current payment model. The result of decades of devaluing children's healthcare has led to a substantial decrease in the availability of services, medications, and equipment needed to provide healthcare to children across the nation. Fortunately, the solution is just as clear as the problem: we must value the healthcare of children as much as that of adults by increasing Medicaid funding to be on par with Medicare and appreciate the complexities of care beyond procedures. If these changes are not made, the high-quality care for children in the US will continue to decline and increase strain on the overall healthcare system as these children age into adulthood.
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Affiliation(s)
- Jordee Wells
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anita Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Holly Gillis
- Department of Anesthesiology, Division of Pediatric Anesthestiology, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Gustafson
- Division of Pediatric Hospital Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Carmin Powell
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amornluck Krasaelap
- Department of Gastroenterology and Hepatology, SeattleChildren’s Hospital, Seattle, WA, United States
| | - Samantha Hanna
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Jennifer A. Hoefert
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Amee Bigelow
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jennifer Sherwin
- Division of Cardiovascular and Thoracic Surgery,Duke University Medical Center, Durham, NC, United States
| | - Emilee C. Lewis
- Division of Hospital Pediatrics, Department of Pediatrics,University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Katherine E. Bline
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
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11
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Liu RT, Bettis AH, Lawrence HR, Walsh RFL, Sheehan AE, Pollak OH, Stephenson AR, Kautz MM, Marlowe RM. Measures of Suicidal Thoughts and Behaviors in Children and Adolescents: A Systematic Review and Recommendations for Use in Clinical and Research Settings. Assessment 2024:10731911241249438. [PMID: 38742801 DOI: 10.1177/10731911241249438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Empirically supported measures of suicidal thoughts and behaviors (STBs) are needed to serve as reference outcomes for suicide risk screening tools and to monitor severity and treatment progress in children and adolescents with STBs. The present paper systematically reviewed existing measures of STBs in youth and studies evaluating their psychometric properties and clinical utility. Measures were then evaluated on reliability, validity, and clinical utility. Sixteen articles (20 independent samples) were found with psychometric data with youth samples for eight measures. Interview-based measures were found to have the strongest psychometric support and clinical utility. Significant limitations exist for all self-report measures due to inherent characteristics of these measures that cannot be remedied through additional psychometric study. There is an urgent need for the development and validation of new self-report measures of STBs, particularly for preadolescent children, sexual and gender minority youth, and racial/ethnic minority youth.
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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12
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Jacobson E, Salada K, Sturza J, Hazle M, Malakh M, Stewart D, Shaw R. Outcomes for Young Adults With Suicide Admitted to Adult Versus Pediatric Hospitals. Hosp Pediatr 2024; 14:385-389. [PMID: 38629158 DOI: 10.1542/hpeds.2023-007691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVES To evaluate differences in care and outcomes for young adults admitted with suicide ideation (SI) or attempt (SA) to medical units of an adult (AH) versus pediatric hospital (PH). METHODS Demographic and clinical characteristics were collected on patients aged 18 to 25 years admitted to either an AH or PH at an academic health system from September 2017 through June 2023 with a diagnosis of SI or SA. Outcomes measured were discharge location, length of stay (LOS), emergency department (ED) visit or hospital readmission, and inpatient consultations. Bivariate tests and multivariate regression were used to determine association of admission location and outcomes. RESULTS Of 212 patients included, 54% were admitted to an AH and 46% to a PH. Admission to a PH compared with an AH was associated with shorter ED LOS (4.3 vs 7.3 hours, P < .01) and discharge to home (57% vs 42%, P = .028) on bivariate but not adjusted analysis. Admission location was not associated with hospital LOS, ED visit or medical readmission after discharge, or psychiatry consultation. Admission to a PH compared with an AH was associated with higher odds of psychology consultation (29 vs 3%, P < .01). CONCLUSIONS Although young adults admitted to a PH for SI/SA had higher rates of psychology consultation, they otherwise had similar care and outcomes regardless of admission to an AH versus a PH. Further work is needed to determine if observed differences are generalizable and how they affect hospital throughput and long-term outcomes.
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Affiliation(s)
- Emily Jacobson
- Department of Pediatrics
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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13
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House SA, Arakelyan M, Acquilano SC, Roche L, Leyenaar JK. Human-Centered Design to Improve Care for Youths Experiencing Psychiatric Boarding. Hosp Pediatr 2024; 14:394-402. [PMID: 38577744 DOI: 10.1542/hpeds.2023-007688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of children and adolescents presenting to hospitals with mental health conditions has increased markedly over the past decade. A dearth of pediatric mental health resources prevents delivering definitive psychiatric care to this population at many hospitals; thus, children and adolescents must wait at a medical facility until appropriate psychiatric care becomes available (an experience described as psychiatric "boarding"). Clinicians caring for youth experiencing psychiatric boarding report inadequate training and resources to provide high-quality care to this population, and patients and caregivers describe significant frustration with the current standard of care. Recognizing these issues and the unique emotional components associated with psychiatric boarding, we employed human-centered design (HCD) to improve our hospital's approach to caring for youth during this period. HCD is an approach that specifically prioritizes the assessment and integration of human needs, including emotional needs, as a means to inform change. We used an HCD framework encompassing 5 stages: (1) empathize with those affected by the issue at hand, (2) define the problem, (3) ideate potential solutions, (4) prototype potential solutions, and (5) test potential solutions. Through these stages, we elicited broad stakeholder engagement to develop and implement 2 primary interventions: A modular digital health curriculum to teach psychosocial skills to youth experiencing boarding and a comprehensive clinical practice guideline to optimize and standardize care across clinical environments at our hospital. This manuscript describes our experience applying HCD principles to this complex health care challenge.
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Affiliation(s)
- Samantha A House
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; and
- The Value Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mary Arakelyan
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire
| | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; and
| | - Leigh Roche
- The Value Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - JoAnna K Leyenaar
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; and
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14
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Luccarelli J, Kalluri AS, Kalluri NS, McCoy TH. Pediatric Physical Restraint Coding in US Hospitals: A 2019 Kids Inpatient Database Study. Hosp Pediatr 2024; 14:337-347. [PMID: 38567417 PMCID: PMC11163444 DOI: 10.1542/hpeds.2023-007562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Reduction of physical restraint utilization is a goal of high-quality hospital care, but there is little nationally-representative data about physical restraint utilization in hospitalized children in the United States. This study reports the rate of physical restraint coding among hospitalizations for patients aged 1 to 18 years old in the United States and explores associated demographic and diagnostic factors. METHODS The Kids' Inpatient Database, an all-payors database of community hospital discharges in the United States, was queried for hospitalizations with a diagnosis of physical restraint status in 2019. Logistic regression using patient sociodemographic characteristics was used to characterize factors associated with physical restraint coding. RESULTS A coded diagnosis of physical restraint status was present for 8893 (95% confidence interval [CI]: 8227-9560) hospitalizations among individuals aged 1 to 18 years old, or 0.63% of hospitalizations. Diagnoses associated with physical restraint varied by age, with mental health diagnoses overall the most frequent in an adjusted model, male sex (adjusted odds ratio [aOR] 1.56; 95% CI: 1.47-1.65), Black race (aOR 1.43; 95% CI: 1.33-1.55), a primary mental health or substance diagnosis (aOR 7.13; 95% CI: 6.42-7.90), Medicare or Medicaid insurance (aOR 1.33; 95% CI: 1.24-1.43), and more severe illness (aOR 2.83; 95% CI: 2.73-2.94) were associated with higher odds of a hospitalization involving a physical restraint code. CONCLUSIONS Physical restraint coding varied by age, sex, race, region, and disease severity. These results highlight potential disparities in physical restraint utilization, which may have consequences for equity.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aditya S. Kalluri
- Harvard Medical School, Boston, MA, USA
- Boston Combined Residency Program in Pediatrics, Boston, MA 02115
| | - Nikita S. Kalluri
- Harvard Medical School, Boston, MA, USA
- Department of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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15
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DePorre AG, Hall M, Bernstein AM, Nadler C, Puls HT. Factors Associated With Prolonged Mental Health Admissions at US Children's Hospitals. Hosp Pediatr 2024; 14:328-336. [PMID: 38584580 DOI: 10.1542/hpeds.2023-007684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Mental health (MH) hospitalizations at medical hospitals are associated with longer length of stay (LOS) compared with non-MH hospitalizations, but patient factors and costs associated with prolonged MH hospitalizations are unknown. The objective of this paper is to assess patient clinical and demographic factors associated with prolonged MH hospitalizations and describe variation in MH LOS across US children's hospitals. METHODS We studied children aged 5 to 20 years hospitalized with a primary MH diagnosis during 2021 and 2022 across 46 children's hospitals using the Pediatric Health Information System database. Generalized estimating equations, clustered on hospital, tested associations between patient characteristics with prolonged MH hospitalization, defined as those in the 95th percentile or above (>14 days). RESULTS Among 42 654 primary MH hospitalizations, most were aged 14 to 18 (62.4%), female (68.5%), and non-Hispanic white (53.8%). The most common primary MH diagnoses were suicide/self-injury (37.4%), depressive disorders (16.6%), and eating disorders (10.9%). The median (interquartile range) LOS was 2 days (1-5), but 2169 (5.1%) experienced a hospitalization >14 days. In adjusted analyses, race and ethnicity, category of MH diagnosis, and increasing medical and MH complexity were associated with prolonged hospitalization. CONCLUSIONS Our results emphasize several diagnoses and clinical descriptors for targeted interventions, such as behavioral and inpatient MH resources and discharge planning. Expanded investment in both community and inpatient MH supports have the potential to improve health equity and reduce prolonged MH hospitalizations.
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Affiliation(s)
- Adrienne G DePorre
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Matt Hall
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
- Childrens Hospital Association, Lenexa, Kansas
| | - Alec M Bernstein
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Cy Nadler
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Henry T Puls
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
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16
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Luehring MC, Romani PW, Ariefdjohan M. Preliminary evaluation of behavior technician burnout when working with boarded and traditional psychiatric inpatients diagnosed with developmental disabilities. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12461. [PMID: 38564318 DOI: 10.1111/jcap.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/22/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
PROBLEM The COVID-19 pandemic has led to a youth mental health crisis, with research demonstrating an increased prevalence of depression, anxiety, and disruptive behavior in youth compared to pre-pandemic years. Consequently, the insurgence of emergency psychiatric evaluations has increased the demands for extended inpatient stay (or patient boarding) at various licensed treatment facilities. Questions remain about the extent of burnout being experienced by behavior technicians who are caring for these patients. METHODS The Shirom-Melamed Burnout Measure was used to evaluate symptoms of burnout of behavior technicians practicing at a specialized psychiatric inpatient unit. Comparisons were made for instances of caring for boarded (meeting criteria for discharge but unable to be discharged due to disposition) and traditional patients (short-term treatment). FINDINGS Behavior technicians caring for boarded patients reported significantly higher scores in overall stress, physical exhaustion, cognitive fatigue, and emotional exhaustion than those managing patients getting traditional care. CONCLUSIONS Extensive burnout can have adverse impacts at both the personal level (staff well-being, individual staff-patient interactions) and clinic level (daily operations and service, general quality of care). Efforts need to be made to address this issue to prevent staff turnover.
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Affiliation(s)
- Mathew C Luehring
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick W Romani
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Merlin Ariefdjohan
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Ibeziako P, Kaufman K, Campbell E, Zou B, Samsel C, Qayyum Z, Caracansi A, Ray A. Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00044-2. [PMID: 38583523 DOI: 10.1016/j.jaclp.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. OBJECTIVES We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. METHODS Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. RESULTS One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]). CONCLUSIONS The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.
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Affiliation(s)
- Patricia Ibeziako
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katy Kaufman
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Emily Campbell
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Billy Zou
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Chase Samsel
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Zheala Qayyum
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Annmarie Caracansi
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Aliza Ray
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
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18
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Ahn-Horst RY, Bourgeois FT. Mental Health-Related Outpatient Visits Among Adolescents and Young Adults, 2006-2019. JAMA Netw Open 2024; 7:e241468. [PMID: 38451523 PMCID: PMC10921253 DOI: 10.1001/jamanetworkopen.2024.1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
Importance Concerns over the mental health of young people have been increasing over the past decade, especially with the rise in mental health burden seen during the COVID-19 pandemic. Examining trends in mental health-related outpatient visits provides critical information to elucidate contributing factors, identify vulnerable populations, and inform strategies to address the mental health crisis. Objective To examine characteristics and trends in mental health-related outpatient visits and psychotropic medication use among US adolescents and young adults. Design, Setting, and Participants A retrospective cross-sectional analysis of nationally representative data from the National Ambulatory Medical Care Survey, an annual probability sample survey, was conducted from January 2006 to December 2019. Participants included adolescents (age 12-17 years) and young adults (age 18-24 years) with office-based outpatient visits in the US. Data were analyzed from March 1, 2023, to September 15, 2023. Main Outcomes and Measures Mental health-related outpatient visits were identified based on established sets of diagnostic codes for psychiatric disorders. Temporal trends in the annual proportion of mental health-related outpatient visits were assessed, including visits associated with use of psychotropic medications. Analyses were stratified by age and sex. Results From 2006 to 2019, there were an estimated 1.1 billion outpatient visits by adolescents and young adults, of which 145.0 million (13.1%) were associated with a mental health condition (mean [SD] age, 18.4 [3.5] years; 74.0 million females [51.0%]). Mental health-related diagnoses were more prevalent among visits by male (16.8%) compared with female (10.9%) patients (P < .001). This difference was most pronounced among young adults, with 20.1% of visits associated with a psychiatric diagnosis among males vs 10.1% among females (P < .001). The proportion of mental health-related visits nearly doubled, from 8.9% in 2006 to 16.9% in 2019 (P < .001). Among all outpatient visits, 17.2% were associated with the prescription of at least 1 psychotropic medication, with significant increases from 12.8% to 22.4% by 2019 (P < .001). Conclusions and Relevance In this cross-sectional study, there were substantial increases in mental health-related outpatient visits and use of psychotropic medications, with greater overall burden among male patients. These findings provide a baseline for understanding post-pandemic shifts and suggest that current treatment and prevention strategies will need to address preexisting psychiatric needs in addition to the effects of the COVID-19 pandemic.
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Affiliation(s)
- Rosa Y. Ahn-Horst
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Florence T. Bourgeois
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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19
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Bayne M, Chirico I, Wei L, Galanter C. Impact of Illness Severity Tools on Adolescent Psychiatric Managed Care in California. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:162-171. [PMID: 38051430 DOI: 10.1007/s10488-023-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
Youth with mental illness struggle to receive essential behavioral health care. One obstacle is denial of coverage by insurance. In California, managed care consumers may apply for independent medical review (IMR) which potentially overturns an insurance denial through the California Department of Managed Healthcare (CDMHC). The authors aim to analyze IMR appeals for psychiatric treatment among adolescents and elucidate factors associated with obtaining coverage of care. We performed an analysis to identify factors that are associated with depression and substance use disorder (SUD) treatment claim denials in 11-20-year-olds from 2001 to 2022 using CDMHC data. Logistic regression modeling was used to identify specific factors related to claim characteristics and medical society instruments that are significantly associated with overturning a denial by IMR. Behavioral health IMRs are overturned at a higher rate than non-behavioral health claims. 54.5% of those with depression and 36.3% of those with SUD initially denied care coverage were overturned by IMR. For those seeking depression treatment, we found a significantly greater odds of overturn by IMR if there was a reference of CALOCUS [1.64, 95%CI (1.06-2.5)]. The odds of a SUD treatment denial being overturned was significantly greater if referencing CALOCUS [3.85 (1.54-9.62)] or ASAM [2.47, [4.3 (1.77-10.47)]. After the standardized implementation of illness severity tools in IMRs, the odds of a medically necessary claim being overturned was 2.5 times higher than before the standards. With a high percentage of claims being overturned after IMR, the findings suggest that health plans inappropriately deny medically necessary behavioral health treatment. The use of medical society instruments was associated with higher odds of overturning a denial. The recent decision of CDMHC to implement standard use of CALOCUS and similar illness severity criteria is supported by our findings and may facilitate more equitable care.
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Affiliation(s)
- Mitchell Bayne
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Isabella Chirico
- Mount Sinai Morningside West, 1090 Amsterdam Ave, New York, NY, 10025, USA
| | - Lulu Wei
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Cathryn Galanter
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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20
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Rappaport DI, Wilding KM, Adkins L, Bourque M, Miller JM. How Will a Shift to Value-Based Financial Models Affect Care for Hospitalized Children? Hosp Pediatr 2024; 14:e177-e180. [PMID: 38351892 DOI: 10.1542/hpeds.2023-007400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- David I Rappaport
- Division of General Academic Pediatrics
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Marie Wilding
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Lisa Adkins
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Maryanne Bourque
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Jonathan M Miller
- Division of General Academic Pediatrics
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
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21
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Davico C, Arletti L, Silverio G, Marcotulli D, Ricci FS, Amianto F, Vitiello B. Suicide in the press: an analysis of newspaper coverage of adolescent versus adult suicides in Italy. Eur Psychiatry 2024; 67:e9. [PMID: 38228324 DOI: 10.1192/j.eurpsy.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND An association between sensationalized media reporting and subsequent increase in suicidal behavior has been documented, and adolescents are especially vulnerable to imitative influences. The aims of this study were to examine the characteristics of the articles reporting adult and adolescent (under age 18) suicides in the Italian press and to assess adherence to the World Health Organization (WHO) guidelines for responsible reporting. Methods: The print versions of the three newspapers with the widest national distribution in Italy were searched for all the articles on incident suicides printed over a 7-month period (July 2022 to February 2023). Articles were examined for adherence to the WHO guidelines. Results: Overall, 213 articles were identified, reporting on 122 individual suicide cases (88.5% adults and 11.5% adolescents). Of the articles, 78.9% were on adults and 21.1% on adolescents, with a ratio articles/suicide cases of 1.6 for adults and 3.2 for adolescents (p < 0.0001). Adolescent suicide articles had more words (mean 612.5 ± SD 275.6) than adult ones (462.1 ± 267.7, p = 0.001). Potentially harmful reporting features were present in both the adult and adolescent articles (12-82%). Few articles (0-15%) included protective features. Articles on adolescents were more adherent to the WHO guidelines for omitting specific information of suicide method and location. Conclusions: Significant differences were found in the press reporting of adolescent versus adult suicides, with adolescent suicides receiving more attention in terms of the number of articles and article length. Suicide press reporting can be improved. A close collaboration between journalists and suicide prevention experts may be beneficial.
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Affiliation(s)
- Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Luca Arletti
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Giulia Silverio
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Federica S Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | | | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Mental Health, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Leyenaar JK. Reverse triage and the pediatric mental health boarding crisis. J Hosp Med 2023; 18:1158-1159. [PMID: 38010297 DOI: 10.1002/jhm.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Affiliation(s)
- JoAnna K Leyenaar
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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23
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Freyleue SD, Arakelyan M, Leyenaar JK. Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States: 2019 update. J Hosp Med 2023; 18:908-917. [PMID: 37661338 DOI: 10.1002/jhm.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND General hospitals (GH) provide inpatient care for the majority of hospitalized children in the United States, yet the majority of hospital pediatrics research is conducted at freestanding children's hospitals. OBJECTIVE Updating a prior 2012 analysis, this study used 2019 data to describe characteristics of pediatric hospitalizations at general and freestanding hospitals in the United States and identify the most common and costly reasons for hospitalization in these settings. DESIGNS, SETTING, AND PARTICIPANTS This study examined hospitalizations in children <18 years using the Healthcare Cost and Utilization Project's 2019 Kids' Inpatient Database, stratifying neonatal and nonneonatal hospital stays. INTERVENTION Not applicable. MAIN OUTCOME AND MEASURES Sociodemographic and clinical differences between hospitalizations at general and freestanding children's hospitals were examined, applying survey weights to generate national estimates. RESULTS There were an estimated 5,263,218 pediatric hospitalizations in 2019, including 3,757,601 neonatal and 1,505,617 nonneonatal hospital stays. Overall, 88.6% (n = 4,661,288) of hospitalizations occurred at GH, including 97.6% of neonatal hospitalizations and 65.9% of nonneonatal hospitalizations. 11.4% (n = 601,930) of hospitalizations occurred at freestanding children's hospitals, including 2.4% (n = 88,313) of neonatal hospitalizations and 34.1% (n = 513,616) of nonneonatal hospitalizations. In total, 98.9% of complicated birth hospitalizations and 66.0% of neonatal nonbirth hospitalizations occurred at GH. Among nonneonatal stays, 85.2% of mental health hospitalizations, 63.5% of medical hospitalizations, and 61.3% of surgical hospitalizations occurred at GH.
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Affiliation(s)
- Seneca D Freyleue
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Mary Arakelyan
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
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24
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Martin D, Lynch S, Becker TD, Shanker P, Staudenmaier P, Leong A, Rice T. Difference in Psychiatric Hospital Admissions Between Cisgender and Transgender and Gender Nonconforming Youth, Before and During the Start of the COVID-19 Pandemic. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01571-4. [PMID: 37464154 DOI: 10.1007/s10578-023-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
This retrospective study of 1101 children and adolescents examines differences in psychiatric admissions between cisgender and transgender/gender nonconforming (TGNC) youth between June 2018 and November 2021. Sociodemographic and clinical characteristics for each admission were extracted from medical records. We compared proportion of total admissions and clinical characteristics between cisgender and TGNC youth, during specified time frames of pre-COVID-19, during quarantine, and post-quarantine. During quarantine, 294 (89.9%) youth identified as cisgender and 33 (10.1%) youth identified as TGNC. Post-quarantine, 205 (88.4%) youth identified as cisgender and 27 (11.6%) identified as TGNC. TGNC patients had more history of mood disorders (p < 0.001), self-injurious behavior (p < 0.001), and suicide attempt (p = 0.007), whereas cisgender patients had more history of Attention-deficit/Hyperactivity Disorder (ADHD) (p = 0.011) and violence (p < 0.001) across each time frame of the study. TGNC patients were more likely to be admitted due to suicidal ideation (p = 0.003), whereas cisgender patients were more often admitted for aggression (p < 0.001). There was no change across COVID-19 time periods in terms of any psychiatric history variable among patients identifying as TGNC. The proportion of admitted youth identifying as TGNC increased by 8.1% from pre-COVID-19 to post-quarantine (p < 0.001). These findings suggest that TGNC youth might be particularly vulnerable to mental health crises when faced with pandemic-related stressors. Further research on the vulnerabilities of TGNC youth during sudden and extreme social changes and how this can impact their mental health is necessary, as global pandemics could and are anticipated to repeat.
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Affiliation(s)
- Dalton Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA.
| | - Sean Lynch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA
| | - Parul Shanker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Paige Staudenmaier
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Alicia Leong
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA
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25
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Manning JC, Marufu TC, Carter T, Bolton S, Breedon P, Craven M, Frost K, Harbottle A, Hendron E, Patel J, Rad L, White P, Wood D, Albelbisi Z, Kaltsa A, Stevenson C, Landa P, Coad J. Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study. Digit Health 2023; 9:20552076231205753. [PMID: 37846405 PMCID: PMC10576941 DOI: 10.1177/20552076231205753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
Background Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches.
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Affiliation(s)
- Joseph C. Manning
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Children and Young People's Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
- School of Healthcare, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Takawira C. Marufu
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Children and Young People's Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Tim Carter
- Centre for Children and Young People's Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Bolton
- The Centre for Healthcare Equipment & Technology Adoption (CHEATA), Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip Breedon
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Michael Craven
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kate Frost
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anthony Harbottle
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Elizabeth Hendron
- Library Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Julian Patel
- East Midlands Academic Health Science Network (EMAHSN), University of Nottingham, Nottingham, UK
| | - Laura Rad
- Clinical Research Division, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Peter White
- Digital and Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Damian Wood
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Zaki Albelbisi
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aikaterina Kaltsa
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Jane Coad
- Centre for Children and Young People's Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
- East Midlands Academic Health Science Network (EMAHSN), University of Nottingham, Nottingham, UK
- Centre for Care excellence, University Hospital Coventry and Warwickshire, NHS Trust, Nottingham, UK
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