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Sanderson C, Verdellen C, Debes N, Tárnok Z, van de Griendt J, Zimmerman-Brenner S, Murphy T. Addressing co-occurring conditions in behavioural therapy for tic disorders: a review and guideline. Eur Child Adolesc Psychiatry 2024; 33:2111-2127. [PMID: 36283996 DOI: 10.1007/s00787-022-02097-1] [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: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
Co-occurring psychiatric conditions are very common in tic disorders and Tourette syndrome. These additional symptoms are often detrimental to quality of life and may impact upon the implementation and efficacy of evidence-based behavioural therapies (BT) for tics. Combining a review of the available literature, relevant theory, and expert clinical practice, we present a guideline for implementing behavioural and psychosocial interventions when common comorbidities are present. These include attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, disruptive behaviour, autism spectrum disorder (ASD) and depression. Practical recommendations are provided for assessment, formulation and management of specific and multiple comorbidities in BT for both children and adults. Despite comorbidities being common in tic disorders, few studies have comprehensively addressed how they may influence the efficacy or implementation of existing therapies or how such treatments may need to be modified or sequenced. We outline recommendations for future research, including randomised control trials of BT for those with specific or multiple comorbidities, as well as adequately powered sub-group analyses within larger scale trials or naturalistic study designs. Transdiagnostic models of psychiatric disorders and treatment, including modular cross-diagnostic therapies, which recognise the dimensionality of psychiatric disorders are also highlighted as an important focus in treatment development in tic disorders.
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Affiliation(s)
- Charlotte Sanderson
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK.
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Cara Verdellen
- PsyQ Nijmegen, Parnassia Group, Sint Annastraat 263, 6525 GR, Nijmegen, The Netherlands
- TicXperts, Julianaweg 7, 6666 CT, Heteren, The Netherlands
| | - Nanette Debes
- Department of Paediatrics, Herlev University Hospital, Borgmester Ib Juuls Vej 25C, 3rd floor, 2730, Herlev, Denmark
| | - Zsanett Tárnok
- VADASKERT Child and Adolescent Psychiatry Hospital and Outpatient Clinic, Lipotmezei str 5, Budapest, 1021, Hungary
| | | | - Sharon Zimmerman-Brenner
- School of Psychology, Reichman University (IDC Herzliya), P.O. Box 167, 4610101, Herzliya, Israel
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
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Giosan C, Pană A, Cosmoiu A, Chira AM, Toma AM, Papasteri CC, Nedelcea C, Popoviciu C. Mental health literacy and academic performance (MHLAP) in high school students: a randomized clinical trial protocol. Trials 2024; 25:419. [PMID: 38937769 PMCID: PMC11212191 DOI: 10.1186/s13063-024-08270-y] [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] [Received: 03/31/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Mental health literacy is a promising avenue of intervention for addressing the development of psychopathology, as well as its associated consequences, such as a decrease in academic performance. The current study aims to test the effectiveness of such an intervention in high school students, focusing on two main formats of delivery: (1) automated and (2) blended. METHODS To achieve this aim, a randomized clinical trial with direct comparisons at three time points between three conditions (automated, blended, and waitlist) was designed. Power analyses yielded a necessary sample size of 264 high school students. The participants will be selected from Romanian high schools. DISCUSSION The current study aims to contribute to the mental health literacy literature by testing the effectiveness of an educational intervention concerning mental health in terms of its benefits for reducing psychopathology and increasing academic performance. The success of such an intervention bears important implications for addressing mental health in the educational system. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT06217744, version 1, 22 January 2024.
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Johnsen DB, Lomholt JJ, Heyne D, Jensen MB, Jeppesen P, Silverman WK, Thastum M. The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01196-8. [PMID: 38739306 DOI: 10.1007/s10802-024-01196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/14/2024]
Abstract
School attendance problems (SAPs) are associated with negative short- and long-term outcomes. Despite high prevalence of SAPs, there is a shortage of evidence-based interventions. Existing approaches often target either school refusal or truancy, leaving a gap in effective interventions addressing both types of SAPs. This randomized controlled trial (RCT) assessed the effectiveness of Back2School (B2S), a modular transdiagnostic cognitive behavioral therapy (CBT) for SAPs, compared to treatment as usual (TAU). Outcomes included youths' school attendance and mental health. A group (B2S, TAU) × time (Pre, Post, 3-Month Follow-Up) design involving 152 youths (B2S; n = 74, TAU; n = 78) with SAPs (i.e., ≥ 10% absence in the past three months), aged 6-16 years (M = 12.2, SD = 2.2, males = 60%) were used. B2S comprised three months of CBT with youths, parents, and school involvement, while TAU comprised public and/or private intervention services. On average, youths in B2S received 15.0, (SD = 3.9) hours of intervention, while those in TAU received 13.4, (SD = 21.6). Intervention effects were investigated using mixed linear models. Both B2S and TAU exhibited significant within-group improvements in school attendance, with no significant differences between them. However, the B2S group significantly outperformed TAU in reducing youths' emotional problems, conduct problems, problems with peers, the overall impact of problems, and increasing youths self-efficacy for attending school and parent self-efficacy for dealing with a SAP. This RCT represents the first evaluation of a modular transdiagnostic CBT for youths displaying SAPs, showing significant mental health and self-efficacy benefits. (Clinical trial registration: ClinicalTrials.gov: NCT03459677).
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Affiliation(s)
- Daniel B Johnsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Johanne J Lomholt
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- TrygFonden's Centre for Child Research, Aarhus University, Aarhus, Denmark
| | - David Heyne
- School of Psychology, Deakin University, Melbourne, Australia
| | - Morten B Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
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Sun Y, Wang H, Wu Y, Luo L, Shi C. Parents' knowledge and attitudes towards extracorporeal membrane oxygenation and their post-traumatic stress symptoms. Sci Rep 2024; 14:10700. [PMID: 38730232 PMCID: PMC11087580 DOI: 10.1038/s41598-024-60880-3] [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] [Received: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
This cross-sectional study, conducted between January 2020 and July 2023, aimed to assess the knowledge, attitude, and post-traumatic stress symptoms (PTSS) among parents with children undergoing extracorporeal membrane oxygenation (ECMO) treatment. Out of 201 valid questionnaires collected, the median knowledge score was 3.00, the mean attitude score was 27.00 ± 3.20, and the mean PTSS score was 3.50 ± 1.54. Logistic regression identified associations between PTSS and parents with lower education levels, particularly junior high school and high school/technical secondary school education, as well as those occupied as housewives. Structural equation modeling highlighted direct effects, such as the impact of residence on education, education on employment status, and associations between knowledge, attitude, PTSS, employment status, monthly income, and parental demographics. The findings indicated inadequate knowledge and suboptimal attitudes among parents, especially those with lower education levels, emphasizing the need for educational resources. Furthermore, addressing parental PTSS through psychosocial support and screening was deemed essential, providing valuable insights for tailored interventions in this context.
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Affiliation(s)
- Yuyan Sun
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Huanhuan Wang
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Yingying Wu
- Rehabilitation Department, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450053, China
| | - Leng Luo
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Caixiao Shi
- Nursing Department, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China.
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5
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Dimitropoulos G, Lindenbach D, Potestio M, Mogan T, Richardson A, Anderson A, Heintz M, Moskovic K, Gondziola J, Bradley J, LaMonica HM, Iorfino F, Hickie I, Patten SB, Arnold PD. Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures. JMIR Res Protoc 2024; 13:e51667. [PMID: 38506921 PMCID: PMC10993112 DOI: 10.2196/51667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/13/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. OBJECTIVE The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. METHODS This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. RESULTS This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. CONCLUSIONS This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51667.
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Affiliation(s)
- Gina Dimitropoulos
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - David Lindenbach
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | | | - Tom Mogan
- Alberta Health Services, Edmonton, AB, Canada
| | | | - Alida Anderson
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | - Madison Heintz
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Scott B Patten
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Paul D Arnold
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
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Rimvall MK, Vassard D, Christensen R, Nielsen SM, Pagsberg AK, Correll CU, Jeppesen P. Do psychotic experiences act as effect modifiers in youths with common mental health problems allocated to transdiagnostic cognitive behavioural therapy versus management as usual? Secondary analyses of the Mind-My-Mind randomized trial. Early Interv Psychiatry 2024; 18:26-33. [PMID: 37078563 DOI: 10.1111/eip.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Psychotic experiences (PEs) are common in help-seeking youths with non-psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems. METHODS We present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6-16-year-old youths to either 9-13 sessions of transdiagnostic modular community-based CBT (MMM) or community-based management as usual (MAU). MMM was superior to MAU in reducing parent-reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi-structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent-reported SDQ-impact (primary outcome, rated 0[low]-10[high]) and other SDQ-related outcomes. RESULTS Baseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ-impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] -0.89 [95%CI -1.77;-0.01] vs. PEs[no] -1.10 [95%CI -1.52;-0.68], p-value for interaction .68). For secondary outcomes similar patterns were observed. Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta-analytic evidence are needed. CONCLUSIONS The beneficial effects of MMM transdiagnostic CBT did not differ by PE-status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co-occurring PEs.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Vassard
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Rimvall MK, Vassard D, Nielsen SM, Wolf RT, Plessen KJ, Bilenberg N, Thomsen PH, Thastum M, Neumer SP, Puggaard LB, Pedersen MMA, Pagsberg AK, Silverman WK, Correll CU, Christensen R, Jeppesen P. Effect modification of an effective transdiagnostic cognitive behavioral psychotherapy in youths with common mental health problems: Secondary analyses of the randomized mind-my-mind trial. Eur Neuropsychopharmacol 2023; 74:64-75. [PMID: 37279641 DOI: 10.1016/j.euroneuro.2023.05.004] [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: 11/21/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
Mind My Mind (MMM) cognitive behavioral therapy (CBT) manualized treatment is effective in the management of common emotional and behavioral mental health problems in youth, yet not all individuals respond satisfactorily to treatment. This study explored potential effect modifiers, i.e., baseline factors associated with a differential treatment effect. We conducted secondary effect modifier analyses with MMM trial data, which involved randomization of 396 youths aged 6-16 years to either MMM CBT treatment (9-13 sessions) or management as usual in local community settings. We examined sociodemographic- (sex, age, family composition, ethnicity, parental education, and income) and clinical variables (mental disorders and duration of mental health problems) as potential effect modifiers of the a) change in parent-rated impact of mental health problems measured by the Strengths and Difficulties Questionnaire (SDQ) or b) response (reduction of ≥1 on SDQ-impact). In intention-to-treat analyses, superior treatment (net) benefits from the MMM intervention were found among youths who met criteria for any mental disorder at baseline (-1.25 [95%CI: -1.67;-0.82]) compared to youths that did not meet diagnostic criteria (-0.22 [95%CI:-1.09;0.65]). Comorbidity vs no comorbidity (-1.84 [95%CI:-2.58;-1.10] vs -0.72 [95%CI:-1.15;-0.29]) and longer duration of untreated mental health problems, i.e., more vs less than 6 months (-1.16 [95%CI:-1.55;-0.78] vs 0.43 [95%CI:-1.01;1.86]) were also associated with superior treatment benefits. The sociodemographic factors were not associated with differential treatment effects in the intention-to-treat analyses. These findings suggest that community-based programs like the MMM are well-suited for youths with substantial mental health problems. Clinical Trials Identifier: NCT03535805.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Vassard
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Rasmus Trap Wolf
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Niels Bilenberg
- Department for Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Per Hove Thomsen
- Research Center at Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Centre for the Psychological Treatment of Children and Adolescents, Department of Psychology and Behavioural Sciences, Aarhus BSS, Aarhus University, Denmark
| | - Simon-Peter Neumer
- Centre for Child and Adolescent Mental Health, Oslo, Norway; The Arctic University of Norway, Centre for Child and Youth Mental Health and Child Welfare, North Norway (RKBU North), Tromsø, Norway
| | - Louise Berg Puggaard
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Mette Maria Agner Pedersen
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Wendy K Silverman
- Anxiety and Mood Disorders Program, Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, United States; The Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, New York, United States; Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, United States; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Wuthrich VM, Zagic D, Dickson SJ, McLellan LF, Chen JTH, Jones MP, Rapee RM. Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2023; 26:824-848. [PMID: 37059918 PMCID: PMC10465434 DOI: 10.1007/s10567-023-00433-8] [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] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24 to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia.
| | - Dino Zagic
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Sophie J Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Jessamine T-H Chen
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
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Midgley N, Mortimer R, Carter M, Casey P, Coffman L, Edbrooke-Childs J, Edridge C, Fonagy P, Gomes M, Kapoor A, Marks S, Martin P, Moltrecht B, Morris E, Pokorna N, McFarquhar T. Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties. PLoS One 2023; 18:e0289503. [PMID: 37590277 PMCID: PMC10434917 DOI: 10.1371/journal.pone.0289503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION Clinical trial registration: ISRCTN 11620914.
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Affiliation(s)
- Nick Midgley
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Rose Mortimer
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Mark Carter
- Barnet, Enfield and Haringey NHS Trust, United Kingdom
| | - Polly Casey
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Chloe Edridge
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Peter Fonagy
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | - Anoushka Kapoor
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Bettina Moltrecht
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Emma Morris
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Nikola Pokorna
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Tara McFarquhar
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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10
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Lu Y, Wang M, Yu C, Wu Q, Mao Z, Li H, Ren L, Zeng J, Xing P, Zhou LJ, Wan S, Wu QL. Unexpected enrichment of antibiotic resistance genes and organic remediation genes in high-altitude lakes at Eastern Tibetan Plateau. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 874:162554. [PMID: 36870490 DOI: 10.1016/j.scitotenv.2023.162554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/07/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Elevation has a strong effect on aquatic microbiome. However, we know little about the effects of elevation on functional genes, especially antibiotic resistance genes (ARGs) and organic remediation genes (ORGs) in freshwater ecosystems. In this study, we analyzed five classes of functional genes including ARGs, metal resistance genes (MRGs), ORGs, bacteriophages, and virulence genes between two high-altitude lakes (HALs) and two low-altitude lakes (LALs) in Mountain Siguniang at Eastern Tibetan Plateau by means of GeoChip 5.0. No differences (Student's t-test, p > 0.05) of gene richness including ARGs, MRGs, ORGs, bacteriophages, and virulence genes in HALs and LALs were found. The abundance of most ARGs and ORGs was higher in HALs than in LALs. For MRGs, the abundance of macro metal resistance genes of potassium, calcium, and aluminum was higher in HALs than in LALs (Student's t-test, p < 0.05; all Cohen's d > 0.8). The abundance of some heavy metal resistance genes of lead and mercury was lower in HALs than in LALs (Student's t-test, p < 0.05; all Cohen's d < -0.8). The composition of these functional genes in HALs differed significantly from in LALs. The functional gene network in HALs was also more complex than that in LALs. We speculate that enrichment of ARGs and ORGs in HALs is related to different microbial communities, exogenous ARGs, and enriched persistent organic pollutants through long-range atmospheric transport driven by the Indian monsoon. This study highlights the unexpected enrichment of ARGs, MRGs, and ORGs in remote lakes at high elevations.
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Affiliation(s)
- Yiwei Lu
- School of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071002, China; State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Man Wang
- School of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071002, China; State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Chunyan Yu
- School of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071002, China; State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Qiong Wu
- School of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071002, China; State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Zhendu Mao
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Huabing Li
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Lijuan Ren
- Department of Ecology, Jinan University, Guangzhou 510632, China
| | - Jin Zeng
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Peng Xing
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
| | - Li-Jun Zhou
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China.
| | - Shiqiang Wan
- School of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071002, China
| | - Qinglong L Wu
- Center for Evolution and Conservation Biology, Southern Marine Sciences and Engineering Guangdong Laboratory (Guangzhou), Guangzhou 511458, China; State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing 210008, China
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11
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Ratheesh A, Hammond D, Gao C, Marwaha S, Thompson A, Hartmann J, Davey C, Zammit S, Berk M, McGorry P, Nelson B. Empirically driven transdiagnostic stages in the development of mood, anxiety and psychotic symptoms in a cohort of youth followed from birth. Transl Psychiatry 2023; 13:103. [PMID: 36990979 PMCID: PMC10052262 DOI: 10.1038/s41398-023-02396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Staging models with transdiagnostic validity across mood, psychotic, and anxiety disorders could advance early intervention efforts as well as our understanding of the common underpinnings of such psychopathology. However, there are few well-supported operationalisations for such transdiagnostic models, particularly in community-based samples. We aimed to explore the inter-relationships among mood, psychotic, and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages. We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety, and psychotic symptoms based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest. This represents moderate symptoms that are likely to be associated with the onset of the need for clinical mental health care. We used questionnaire and clinic data completed by young people ages 18 and 21 years. We used descriptive methods and network analyses to examine the overlap among Stage 1b psychopathology. We then examined the patterns of relationships between several risk factors and 1b stages using logistic regressions. Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Descriptive and network analyses indicated that 1b level depressive, anxiety, and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive, and psychotic 1b stages were associated with the female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors. Given their inter-relationships and similar risk factors, anxiety, psychotic and depressive, symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Dylan Hammond
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Caroline Gao
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical school, University of Warwick, Coventry, England
| | - Jessica Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher Davey
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Stanley Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael Berk
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Barwon Health, Geelong, Australia
| | - Patrick McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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12
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Kjøbli J, Melendez-Torres GJ, Gardner F, Backhaus S, Linnerud S, Leijten P. Research review: Effects of parenting programs for children's conduct problems on children's emotional problems - a network meta-analysis. J Child Psychol Psychiatry 2023; 64:348-356. [PMID: 36097742 PMCID: PMC10087885 DOI: 10.1111/jcpp.13697] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Specific programs are often implemented for specific child mental health problems, while many children suffer from comorbid problems. Ideally, programs reduce a wider range of mental health problems. The present study tested whether parenting programs for children's conduct problems, and which individual and clusters of program elements, have additional effects on children's emotional problems. METHODS We updated the search of a previous systematic review in 11 databases (e.g., PsycINFO and MEDLINE) and included studies published until July 2020 with keywords relating to 'parenting', 'program', and 'child behavioral problems'. Also, we searched for recent trials in four trial registries and contacted protocol authors. Studies were eligible for inclusion if they used a randomized controlled trial to evaluate the effects of a parenting program for children aged 2-10 years which was based on social learning theory and included a measure of children's emotional problems postintervention. RESULTS We identified 69 eligible trials (159 effect sizes; 6,240 families). Robust variance estimation showed that parenting programs had small significant parent-reported additional effects on emotional problems immediately postintervention (Cohen's d = -0.14; 95% CI, -0.21, -0.07), but these effects faded over time. Teachers and children did not report significant effects. Additional effects on emotional problems were larger in samples with clinical baseline levels of such problems. No individual program elements predicted larger additional effects. Of the clusters of elements, combining behavior management and relationship enhancement elements was most likely to yield the strongest additional effects. CONCLUSIONS The additional effects on emotional problems of parenting programs designed to reduce conduct problems are limited, but some clusters of elements predict larger effects. Our findings may contribute to realistic expectations of the benefits of parenting programs for children's conduct problems and inform the development of programs with wider benefits across mental health problems.
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Affiliation(s)
- John Kjøbli
- Regional Center for Child and Adolescent Mental Health, Oslo, Norway.,Department of Education, University of Oslo, Oslo, Norway
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sophia Backhaus
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Siv Linnerud
- Regional Center for Child and Adolescent Mental Health, Oslo, Norway
| | - Patty Leijten
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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13
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Bobbitt S, Kawamura A, Saunders N, Monga S, Penner M, Andrews D. Anxiety in children and youth: Part 2-The management of anxiety disorders. Paediatr Child Health 2023; 28:52-66. [PMID: 36865757 PMCID: PMC9971334 DOI: 10.1093/pch/pxac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2022] [Indexed: 03/04/2023] Open
Abstract
Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.
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Affiliation(s)
- Susan Bobbitt
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Anne Kawamura
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Natasha Saunders
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Suneeta Monga
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Melanie Penner
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Debra Andrews
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
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14
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Greenberg E, Albright C, Hall M, Hoeppner S, Miller S, Farley A, Silverman M, Braddick V, Sprich S, Wilhelm S. Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders, Co-Occurring ADHD, and Psychosocial Impairment. Behav Ther 2023; 54:51-64. [PMID: 36608977 DOI: 10.1016/j.beth.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10-17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.
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Affiliation(s)
| | | | | | | | | | - Alyssa Farley
- Boston University Center for Anxiety and Related Disorders
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15
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Kim SW, Hyun S, Kim JK, Kim H, Jhon M, Kim JW, Park C, Lee JY, Kim JM. Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders. Early Interv Psychiatry 2023; 17:29-38. [PMID: 35338567 DOI: 10.1111/eip.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. METHODS This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. RESULTS Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. CONCLUSIONS Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Sumi Hyun
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Kyoung Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Cheol Park
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Peace & Harmony Psychiatry Clinic, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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16
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Russette HC, Grubin F, Ingalls A, Martin L, Leonard A, Kushman E, Cisler A, Leffler E, Herman A, Haroz EE. Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families. Infant Ment Health J 2022; 43:744-755. [PMID: 35921432 DOI: 10.1002/imhj.22012] [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] [Received: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Family Spirit (FS) is a federally endorsed evidence-based home visiting programs serving as a key prevention strategy for expectant families and families with young children. Like other home-visiting programs, it shares client challenges in retention and engagement during implementation. We assessed (1) the feasibility and acceptability of implementing a precision approach to FS; and (2) differences in approaches to FS delivery. Home visitors, serving primarily Native American families, that delivered a standard (N = 6) or a precision approach (N = 6) to FS across four study sites each participated in up to four virtual focus group discussions (FGDs) (N = 16). Facilitators and barriers to implementation were identified across the curriculum approach, relational and contextual levels. Facilitators: Relevant and culturally sensitive lessons, lesson structure, client-home visitor relationship, client buy-in, home visitor autonomy, leadership support, flexible funding, and training. Barriers: Irrelevant lessons, substance use content, missing topics, families experiencing crises, client and home visitor availability, client feedback, nonsupportive leadership, inadequate funding, and organizational policies and practices. The precision approach offers (1) tailoring of lessons that supports relevance of content to clients; and (2) a target timeframe that supports flexibility in lesson delivery. This model structure may improve client participation and retention.
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Affiliation(s)
- Helen C Russette
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Martin
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Amanda Leonard
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Elizabeth Kushman
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, Michigan, USA
| | | | | | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 172] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Jerrott S, Clark S, Chorney J, Coulombe A, Wozney L. Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study. JMIR Form Res 2022; 6:e35685. [PMID: 35738559 PMCID: PMC9382550 DOI: 10.2196/35685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. OBJECTIVE To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. METHODS A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. RESULTS A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. CONCLUSIONS Results are preliminary but show that brief, core skill-focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention.
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Affiliation(s)
- Susan Jerrott
- Mental Health and Addictions Program, Nova Scotia Health, Dartmouth, NS, Canada
| | | | - Jill Chorney
- IWK Health, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health, Dartmouth, NS, Canada
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19
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Wolf RT, Jeppesen P, Pedersen MMA, Puggaard LB, Thastum M, Bilenberg N, Thomsen PH, Silverman WK, Plessen KJ, Neumer SP, Correll CU, Pagsberg AK, Gyrd-Hansen D. Cost-effectiveness of a transdiagnostic psychotherapy program for youth with common mental health problems. BMC Health Serv Res 2022; 22:819. [PMID: 35739556 PMCID: PMC9229821 DOI: 10.1186/s12913-022-08187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Our objective was to evaluate the cost-effectiveness of the transdiagnostic psychotherapy program Mind My Mind (MMM) for youth with common mental health problems using a cost-utility analysis (CUA) framework and data from a randomized controlled trial. Furthermore, we analyzed the impact of the choice of informant for both quality-of-life reporting and preference weights on the Incremental Cost-Effectiveness Ratio (ICER). METHODS A total of 396 school-aged (6-16 years) youth took part in the 6-month trial carried out in Denmark. CUAs were carried out for the trial period and four one-year extrapolation scenarios. Costs were based on a combination of budget and self-reported costs. Youths and parents were asked to report on the youth's quality-of-life three times during the trial using the Child Health Utility 9D (CHU9D). Parental-reported CHU9D was used in the base case together with preference weights of a youth population. Analyses using self-reported CHU9D and preference weights of an adult population were also carried out. RESULTS The analysis of the trial period resulted in an ICER of €170,465. The analyses of the one-year scenarios resulted in ICERs between €23,653 and €50,480. The ICER increased by 24% and 71% compared to the base case when using self-reported CHU9D and adult preference weights, respectively. CONCLUSION The MMM intervention has the potential to be cost-effective, but the ICER is dependent on the duration of the treatment effects. Results varied significantly with the choice of informant and the choice of preference weights indicating that both factors should be considered when assessing CUA involving youth.
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Affiliation(s)
- Rasmus Trap Wolf
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark.
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Smedegade 16, 4000, Roskilde, Denmark
| | - Mette Maria Agner Pedersen
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
| | - Louise Berg Puggaard
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
| | - Mikael Thastum
- Centre for the Psychological Treatment of Children and Adolescents, Department of Psychology and Behavioural Sciences, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Niels Bilenberg
- Department for Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Institute of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Per Hove Thomsen
- Research Center at the Department for Child- and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Wendy K Silverman
- Anxiety and Mood Disorders Program, Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Simon-Peter Neumer
- Centre for Child and Adolescent Mental Health, Oslo, Norway
- The Arctic University of Norway, Centre for Child and Youth Mental Health and Child Welfare, North Norway (RKBU North), Tromsø, Norway
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
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20
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Khetarpal SK, Auster LS, Miller E, Goldstein TR. Transition age youth mental health: addressing the gap with telemedicine. Child Adolesc Psychiatry Ment Health 2022; 16:8. [PMID: 35109881 PMCID: PMC8809232 DOI: 10.1186/s13034-022-00444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
Transition age youth (TAY), a demographic spanning ages 15-26, navigate a myriad of developmental transitions, ranging from identity formation and intimate relationships to substance use. Unfortunately, many young adults continue to have a dearth of mental health services and programing tailored to their unique developmental needs. Moreover, the systems of care in place are generally designed for treating traditional pediatric and adult patients but not ideally suited to meet the needs of TAY. Given the additional stressors from the COVID-19 pandemic, TAY are now, more than ever, in need of routine mental health care. We posit that the rapid expansion of telemedicine programming developed in response to the pandemic could be beneficial in mitigating this historic gap in care. In this commentary, we call on mental health providers and researchers to expand and invest in the growing number of telemedicine interventions and programming for this population so that TAY can begin to receive the care they so desperately need.
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Affiliation(s)
- Susheel K. Khetarpal
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA
| | - Lauren S. Auster
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | - Elizabeth Miller
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA ,grid.239553.b0000 0000 9753 0008Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Tina R. Goldstein
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA ,Department of Psychiatry, Western Psychiatric Hospital, Pittsburgh, PA USA
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21
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Shenk CE, Keeshin B, Bensman HE, Olson AE, Allen B. Behavioral and pharmacological interventions for the prevention and treatment of psychiatric disorders with children exposed to maltreatment. Pharmacol Biochem Behav 2021; 211:173298. [PMID: 34774585 PMCID: PMC8643336 DOI: 10.1016/j.pbb.2021.173298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/20/2021] [Accepted: 11/08/2021] [Indexed: 01/21/2023]
Abstract
There is a well-established relation between exposure to child maltreatment and the onset and course of multiple, comorbid psychiatric disorders. Given the heterogeneous clinical presentations at the time services are initiated, interventions for children exposed to maltreatment need to be highly effective to curtail the lifelong burden and public health costs attributable to psychiatric disorders. The current review describes the most effective, well-researched, and widely-used behavioral and pharmacological interventions for preventing and treating a range of psychiatric disorders common in children exposed to maltreatment. Detailed descriptions of each intervention, including their target population, indicated age range, hypothesized mechanisms of action, and effectiveness demonstrated through randomized controlled trials research, are presented. Current limitations of these interventions are noted to guide specific directions for future research aiming to optimize both treatment effectiveness and efficiency with children and families exposed to maltreatment. Strategic and programmatic future research can continue the substantial progress that has been made in the prevention and treatment of psychiatric disorders for children exposed to maltreatment.
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Affiliation(s)
- Chad E Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University, 115 Health and Human Development Building, University Park, PA 16802, USA; Department of Pediatrics, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA.
| | - Brooks Keeshin
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, 5021 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Heather E Bensman
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Anneke E Olson
- Department of Human Development and Family Studies, The Pennsylvania State University, 115 Health and Human Development Building, University Park, PA 16802, USA.
| | - Brian Allen
- Department of Pediatrics, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA; Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA.
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22
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Rasmussen LMP, Patras J, Handegård BH, Neumer SP, Martinsen KD, Adolfsen F, Sund AM, Martinussen M. Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure. Front Psychol 2021; 12:702565. [PMID: 34262514 PMCID: PMC8273386 DOI: 10.3389/fpsyg.2021.702565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Adherence and competence are essential parts of program fidelity and having adequate measures to assess these constructs is important. The Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS CBT) was developed to evaluate the delivery of cognitive therapies for children with clinical anxiety. The present study is an assessment of the slightly adapted version of the CAS CBT evaluating the delivery of a Cognitive Behavioral Therapy (CBT)-based preventive group intervention: EMOTION: Kids Coping with Anxiety and Depression. This study was part of a Norwegian cluster randomized controlled trial (cRCT) investigating the effectiveness of a transdiagnostic intervention, the EMOTION program—an indicated prevention program targeting anxious and depressive symptoms. The applicability and psychometric properties of the CAS CBT were explored. Results are based on six raters evaluating 239 video-recorded sessions of the EMOTION program being delivered by 68 trained group leaders from different municipal services. Interrater reliability (intraclass correlation coefficients, ICC [3, 1]) indicated fair to good agreement between raters. Internal consistency of the instrument's key domains was calculated using the Omega coefficient which ranged between 0.70 to 0.94. There was a strong association between the two scales Adherence and Competence, and inter-item correlations were high across the items, except for the items rating the adherence to the session goals. Competence and Adherence Scale for Cognitive Behavioral Therapy is a brief measure for use in first-line services, with some promising features for easily assessing program fidelity, but some of the results indicated that the instrument should be improved. Future attention should also be made to adapt the instrument to fit better within a group setting, especially regarding evaluation of session goals. More research on how to adequately evaluate fidelity measures are also warranted. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02340637.
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Affiliation(s)
- Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Joshua Patras
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Simon-Peter Neumer
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.,Centre for Child and Adolescent Mental Health, Oslo, Norway
| | - Kristin Dagmar Martinsen
- Centre for Child and Adolescent Mental Health, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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23
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Post RM, Grunze H. The Challenges of Children with Bipolar Disorder. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57060601. [PMID: 34207966 PMCID: PMC8230664 DOI: 10.3390/medicina57060601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.
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Affiliation(s)
- Robert M. Post
- School of Medicine, George Washington University, Washington, DC 20052, USA
- Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA
- Correspondence:
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Campus ZfPG, 74523 Schwäbisch Hall, Germany;
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
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24
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Wolf RT, Ratcliffe J, Chen G, Jeppesen P. The longitudinal validity of proxy-reported CHU9D. Qual Life Res 2021; 30:1747-1756. [PMID: 33582966 PMCID: PMC8178153 DOI: 10.1007/s11136-021-02774-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives The Child Health Utility 9D (CHU9D) currently represents the only preference-based health-related quality-of-life instrument designed exclusively from its inception for application with children. The objective of this study was to examine the construct validity and responsiveness of the proxy-reported (parent) CHU9D in a mental health setting using utility weights derived from an adult and adolescent population, respectively. Methods The discriminant validity and convergent validity were examined using the mental health-specific ‘The Strengths and Difficulties Questionnaire’ (SDQ) and the generic KIDSCREEN-27. Responsiveness was assessed by examining the floor-ceiling effects, the magnitude of change over time, and the ability to differentiate between improvement and no improvement. Results The study included 396 children with mental health problems. CHU9D showed good construct validity, with correlation coefficients ranging between 0.329 and 0.571 for SDQ Impact score and KIDSCREEN-27 Psychological Well-being. CHU9D was able to distinguish between groups of children with different levels of mental health problems (p < 0.001). The absolute magnitudes of the group mean differences were larger using adolescent weights. No evidence of a floor/ceiling effect was found at the baseline. A standardized response mean of 0.634–0.654 was found for the children who experienced clinically significant improvements. CHU9D was able to discriminate between children who experienced positive and no health improvements (p < 0.001). Conclusion This study provides the first evidence on responsiveness for CHU9D in a mental health context. The findings demonstrate that CHU9D is an appropriate HRQOL measure for use in mental health trials. Furthermore, the results show that the preference weights generated from an adolescent population resulted in the larger mean differences between groups. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02774-9.
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Affiliation(s)
- Rasmus Trap Wolf
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark. .,Child and Adolescent Mental Health Centre, Mental Health Services-Capital Region of Denmark, Odense, Denmark.
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Pia Jeppesen
- Child and Adolescent Mental Health Centre, Mental Health Services-Capital Region of Denmark, Odense, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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