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O'Brien MJ, Pauls AM, Cates AM, Larson PD, Zorn AN. Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior. J Pediatr 2024; 271:114056. [PMID: 38615943 DOI: 10.1016/j.jpeds.2024.114056] [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: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA; The University of Iowa Stead Family Department of Pediatrics, Iowa City, IA.
| | | | | | - Priya D Larson
- The University of Iowa, Iowa City, IA; The University of Iowa Department of Child and Adolescent Psychiatry, Iowa City, IA
| | - Alithea N Zorn
- The University of Iowa, Iowa City, IA; Center for Public Health Statistics, Iowa City, IA; College of Public Health, Iowa City, IA
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Zhao M, You Y, Gao X, Li L, Li J, Cao M. The effects of a web-based 24-hour movement behavior lifestyle education program on mental health and psychological well-being in parents of children with autism spectrum disorder: A randomized controlled trial. Complement Ther Clin Pract 2024; 56:101865. [PMID: 38824831 DOI: 10.1016/j.ctcp.2024.101865] [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: 03/15/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND PURPOSE Compared with parents of neurotypical children or children diagnosed with other disabilities, parents of children with autism spectrum disorder (ASD) often experience poorer mental health, greater stress, and more depression and anxiety symptoms. This study aimed to assess the effects of a web-based 24-h movement behavior lifestyle education program on mental health and psychological well-being in parents of children with ASD. METHODS This study employed a randomized controlled trial utilizing the Health Action Process Approach (HAPA) as a theoretical framework. A total of 318 parents of children with ASD were enrolled and randomly assigned to the experimental or control group. The experimental group received an 8-week web-based 24-h movement behavior lifestyle education program, while the control group followed their usual routine. Two instruments, the Depression Anxiety and Stress Scale (DASS-21) and the Satisfaction With Life Scale (SWLS), were used to measure mental health and psychological well-being, respectively. The data were collected at two time points-at the beginning and the end of the intervention. RESULTS Compared with the baseline and control groups, the experimental group demonstrated significant improvements in all outcome measures (p < 0.01). There were significant differences in the DASS-21 and SWLS scores between the two groups before and after the intervention (p ≤ 0.01). CONCLUSION This study represents the first randomized controlled trial involving a web-based 24-h movement behavior lifestyle education program specifically designed to address the mental health and psychological well-being of parents of children with ASD. The findings confirm the potential impact of 24-h movement behavior lifestyle education as a functional and effective strategy for parents of children with ASD.
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Affiliation(s)
- Mengxian Zhao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Yonghao You
- Department of Sports Science, Hefei Normal University, Hefei, 230061, China
| | - Xinsong Gao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Linlin Li
- School of Sports Social Science, Shandong Sport University, Jinan, 250102, China
| | - Jiayun Li
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Meng Cao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China.
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Calear AL, McCallum SM, Kazan D, Torok M, Werner-Seidler A, O'Dea B, Morse A, Farrer L, Shand F, Batterham PJ. Randomised controlled trial of an online mental health and suicide gatekeeper resource for parents and caregivers: study protocol. BMJ Open 2024; 14:e082963. [PMID: 39019636 PMCID: PMC11256068 DOI: 10.1136/bmjopen-2023-082963] [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: 12/08/2023] [Accepted: 06/25/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Rates of help-seeking for mental disorders and suicide are low among children and adolescents. Parents are viewed as gatekeepers for their care, yet they may lack the knowledge and skills to identify needs or facilitate service access. The primary aim is to test the effect of a new gatekeeper resource for parents and caregivers on their self-efficacy to recognise, respond and access support for mental health problems and suicide risk in their child. METHODS AND ANALYSIS A two-arm randomised controlled trial will compare an online mental health and suicide gatekeeper resource for parents and caregivers to a waitlist control. Australian parents of children aged 5-17 years recruited through social media and community advertising will participate in an online trial. Participants randomised to the intervention condition will be emailed the resource to work through at their own pace. The resource consists of three sections providing parents and caregivers with confidence, knowledge and skills to recognise and respond to mental health problems and suicide risk in their child, as well as support them in accessing professional help. The primary outcome measure is self-efficacy to recognise, respond and provide support for mental health problems and suicide risk, while secondary outcomes include perceived knowledge, stigma, literacy, help-seeking attitudes, intentions and barriers. Data will be collected at preintervention, postintervention (4 weeks after accessing the resource) and 12-week follow-up. Primary analyses will compare changes in self-efficacy in the intervention condition relative to the waitlist control using mixed-model repeated measures analyses. ETHICS AND DISSEMINATION The ethical aspects of the study were approved by the Australian National University Human Research Ethics Committee (Protocol 2023/195). If effective, the resource will fill an important gap in resources for parents, with the potential for dissemination through school groups, community organisations and clinical settings. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry, ACTRN12623000933651.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Dominique Kazan
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Alyssa Morse
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
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Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
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Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Zink J, Weniger M, Porst PT, Siegmund CB, McDonald M, Rückert F, Roessner V, Knappe S, Beesdo-Baum K. Indicated Prevention for Children Screened in Routine Health Care: Effectiveness of a Social Skills Program on Social Anxiety and Depressive Symptoms. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01221-w. [PMID: 38963517 DOI: 10.1007/s10802-024-01221-w] [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: 06/03/2024] [Indexed: 07/05/2024]
Abstract
Social anxiety is common in childhood and potentially transitions into clinical disorders including depression. The present study aimed to examine the effectiveness of an indicated prevention program for children screened in routine care. Data came from the PROMPt project, a prospective implementation study (10/2018-09/2022) that explored a novel care chain, starting with screening with the Strengths and Difficulties Questionnaire (SDQ) as part of regular health check-ups, followed by indicated assignment and participation in a prevention program. Questionnaires assessing anxiety and depression symptoms were administered shortly after screening or before program participation (T0), six months after screening or after program participation (T1) and at a follow-up, six months after T1 (T2). Children who participated in a group cognitive-behavioral social skills program (TT; n = 145) were compared using mixed model analyses with non-participating children who were either screened as normal (NOR; n = 894) or refused program participation despite indication (NoTT; n = 67). TT scores improved from T0 to T1 compared to NOR and NoTT (anxiety β = -0.71 and β = -0.71, social anxiety β = -0.46 and β = -0.52, depression β = -0.52 and β = -0.73). Improvement was maintained at T2. Moderation analyses showed a trend toward greater benefit for participants with higher baseline scores. Indicated prevention can improve anxiety and depression symptoms in children identified by screening in routine care. Systematic screening and targeted prevention may positively affect mental health of children on a population level.
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Affiliation(s)
- Julia Zink
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany.
| | - Max Weniger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Patricia Theresa Porst
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Cornelia Beate Siegmund
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Maria McDonald
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Susanne Knappe
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
- Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing, Dürerstraße 25, 01307, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, Jansen W. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:2051-2065. [PMID: 36129544 PMCID: PMC9490713 DOI: 10.1007/s00787-022-02077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/19/2022]
Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.
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Affiliation(s)
- S Verhoog
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D G M Eijgermans
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Y Fang
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W Jansen
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands.
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Hodgins M, McHugh C, Eapen V, Georgiou G, Curtis J, Lingam R. Creation of the Youth Integration Project Framework: A Narrative Synthesis of the Youth Mental Health Integrated Care Literature. Int J Integr Care 2024; 24:5. [PMID: 38974205 PMCID: PMC11225559 DOI: 10.5334/ijic.7730] [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: 08/08/2023] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Integrated care has been posited as a potential solution to the global burden of youth mental health (YMH), but there is limited evidence on how best to design, staff, and evaluate different integrated care models. Our review aimed to consolidate the evidence on integrated models of mental healthcare for young people, to identify the core components of integration, and create a framework that can be used to analyse levels of YMH integration. Methods We conducted a systematic review of literature across PubMed, SCOPUS, and PsycINFO databases and the grey literature We performed a narrative synthesis extracting core components of integrated YMH care. Results Inductive themes from the literature described core components of integrated care. These themes were mapped into a novel framework combining the World Health Organisation health system building blocks and six intensity levels of integrated care to consider how best to implement and sustain integrated care within the YMH system. Discussion The Youth Integration Project framework can form a basis for the development, implementation and evaluation of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care.
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Affiliation(s)
- Michael Hodgins
- Population Child Health Research Group, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, Australia
| | - Catherine McHugh
- Mindgardens Neuroscience Network, Sydney, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry, University of New South Wales, Sydney, Australia
- Academic Unit of Infant Child and Adolescent Psychiatry Services, South Western Sydney Local Health District, Australia
| | - Gabrielle Georgiou
- Discipline of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jackie Curtis
- Mindgardens Neuroscience Network, Sydney, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Wu J, Zhang R, Zhao L, Yin Y, Min J, Ge Y, Luo Y, Li P, Li L, Tong Y. Risk factors for subsequent suicidal acts among 12-25-year-old high-risk callers to a suicide prevention hotline in China: a longitudinal study. Child Adolesc Psychiatry Ment Health 2024; 18:73. [PMID: 38898519 PMCID: PMC11188529 DOI: 10.1186/s13034-024-00765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap. METHODS This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used. RESULTS During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts. CONCLUSIONS While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers' high psychological distress and suicide intent.
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Affiliation(s)
- Jianlan Wu
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Ruoyun Zhang
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Yi Yin
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Jing Min
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yiming Ge
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yang Luo
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Peiyao Li
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Lingling Li
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yongsheng Tong
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096.
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.
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Hurley J, Longbottom P, Bennett B, Yoxall J, Hutchinson M, Foley KR, Happell B, Parkes J, Currey K. Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review. Aust J Rural Health 2024; 32:462-474. [PMID: 38572866 DOI: 10.1111/ajr.13119] [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: 12/03/2023] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. OBJECTIVE To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. DESIGN A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. FINDINGS Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. DISCUSSION The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. CONCLUSION A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.
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Affiliation(s)
- John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Paula Longbottom
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Bindi Bennett
- Federation University, Ballarat, Victoria, Australia
| | - Jacqui Yoxall
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kitty-Rose Foley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Jill Parkes
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kate Currey
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Kodzo LD, Danso NAA, Budu JT, Akriti KB, Hussain A, Zhang R. Experience of psychosocial rehabilitation; perspectives of depressed adolescents. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02473-z. [PMID: 38809300 DOI: 10.1007/s00787-024-02473-z] [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: 03/28/2023] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
Given the multifaceted character of depression and its related symptoms, an adolescent living with it is at increased risk for a wide range of adverse events. This research aimed to understand and characterize the psychosocial rehabilitation experiences of depressed teenage participants in the Greater Accra Region of Ghana. A cross-sectional semi-structured interview design influenced by an interpretive phenomenological analysis (IPA) technique was adopted. We employed a nonprobability, purposeful sampling approach to recruit twenty-one adolescents (6 males, 15 females) diagnosed with depression from the community after one month of discharge from admission and undergoing psychosocial rehabilitation. Using separate interviews, we gathered and analyzed data using interpretive phenomenological analysis to produce themes and sub-themes. These were presented with the participants' direct quotations. We discovered that the perspectives of adolescents' psychosocial rehabilitation experience include hopelessness and suicide ideation, coping difficulties, undesirable attitudes from support networks, challenges related to school, and isolation. Participants suggested appropriate therapeutic environments, encouraging support systems, and the media's role in preventing and treating depression among young people as rehabilitation approaches that could assist adolescents to remain lucid for longer intervals. These results shed light on the tragic realities faced by depressed adolescents. There is an urgent need to put well-defined structures in place to aid their rehabilitation and develop coping strategies for a better life.
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Affiliation(s)
- Lalit Dzifa Kodzo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Nursing and Midwifery Training College, Central Region, Twifo Praso, Ghana
- School of International Education, Southern Medical University, Guangzhou, China
- Organization of African Academic Doctors (OAAD), Off Kamiti Road, Nairobi, Kenya
| | | | | | | | - Abid Hussain
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Ruixing Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
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11
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Kajüter J, Schaap G, Sools A, Simões JP. Using Participatory Action Research to Redirect Tinnitus Treatment and Research-An Interview Study. J Clin Med 2024; 13:3099. [PMID: 38892817 PMCID: PMC11172774 DOI: 10.3390/jcm13113099] [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: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Chronic bothersome tinnitus is a prevalent tinnitus subtype placing a high burden on affected individuals, economies, and healthcare systems. Patient and professional perspectives seem to be partly misaligned on how to improve tinnitus research and treatments in the future. This qualitative interview study was aimed at exploring, comparing, and stipulating the perspectives of different tinnitus stakeholder groups on ways of redirecting research and treatments to reduce patients' suffering while accounting for challenges within these practices. Methods: This study used the participatory action research approach to facilitate the stakeholder involvement. Semi-structured online interviews including five participants (two tinnitus patients, two tinnitus researchers and medical specialists, one general practitioner) were conducted. Inductive grounded theory and the constant comparative method were used for data analysis. Results: Four categories for suggested research adaptations ((I) ethical patient involvement; (II) prioritising cure versus coping research; (III) funding; (IV) ethical publication) and six categories for suggested treatment adaptations ((I) ethical professional support; (II) patient involvement; (III) interdisciplinarity; (IV) professional tinnitus education; (V) clinical treatment guidelines; (VI) psychological treatment) were identified. Participants held partly similar priorities such as increasing pathophysiological and cure research. Differences between participants included, for instance, patients aiming for increasing patient involvement in tinnitus research and treatments compared to professionals arguing that the excessive focus on patients' conditions might reduce the patients' chances of habituating to their symptoms. Conclusions: Four action redirections for improving tinnitus research and treatment practices were defined: (I) facilitating communication between and within stakeholder groups, (II) increasing the reflective use of patient involvement, (III) increasing interdisciplinarity, and (IV) reducing barriers to receiving psychological treatment.
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Affiliation(s)
| | | | | | - Jorge Piano Simões
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
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12
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Montague LA, Hespos S, Mackenzie E, Siette J. Parental acceptance of brain health programs for preschool children: a mixed-methods study exploring barriers, facilitators and future approaches. Front Public Health 2024; 12:1383270. [PMID: 38883200 PMCID: PMC11177877 DOI: 10.3389/fpubh.2024.1383270] [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: 02/07/2024] [Accepted: 05/03/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recent research proposes that as much as 40% of dementia risk is amendable. Promoting healthy lifestyle behaviors in early life through educational methods can cultivate habits that may decrease dementia risk in later life. This study explores parental acceptance of brain health programs tailored for preschool children, aiming to identify barriers and facilitators affecting parental and child engagement. Methods Mixed-methods cross-sectional study. Urban and suburban parents (N = 187, M age = 37.3 SD = 5.53, range = 29) of children aged three to five years across Australia. Parents participated in an online survey containing both open and closed questions exploring their personal views and opinions on brain health programs for their preschool children. Descriptive statistics, multiple linear regression analyses, and thematic analysis were used to explore sociodemographic factors associated with parental program acceptance. Results Most participants accepted a brain health program with over 98% agreeing a program would be useful for their child(ren). Participants with younger aged children were more likely to exhibit acceptance of a program (β = -0.209, p = 0.007). Three main categories emerged: dual home and preschool environments, the need for engaging brain health programs that were hands-on and screen-free, and addressing key barriers such as time and financial constraints to support implementation. Conclusion Participants valued educating their children for a healthy life and viewed brain health programs favorably. This study contributes to early childhood education discussions, offering guidance for future generations' brain health and wellbeing.
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Affiliation(s)
- Lily A Montague
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, Australia
| | - Susan Hespos
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, Australia
| | - Erin Mackenzie
- School of Education, Western Sydney University, Kingswood, NSW, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, Australia
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13
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Hedstrom E, Kostyrka-Allchorne K, French B, Glazebrook C, Hall CL, Kovshoff H, Lean N, Sonuga-Barke E. Process evaluation of a Structured E-parenting Support (STEPS) in the OPTIMA randomised controlled trial: a protocol. BMJ Open 2024; 14:e081563. [PMID: 38760045 PMCID: PMC11103228 DOI: 10.1136/bmjopen-2023-081563] [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: 11/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Structured E-parenting Support (STEPS) is a digital application (app) designed to help parents manage behaviour of their children who are referred to mental health services and are waiting for an assessment or treatment. STEPS is currently being evaluated in the Online Parent Training for the Initial Management of Attention-Deficit/Hyperactivity Disorder randomised controlled trial. Alongside the examination of STEPS' clinical and cost-effectiveness, we are conducting a process evaluation to better understand the contextual factors that may influence study outcomes. The purpose of this protocol is to describe the aims, objectives and methodology of the process evaluation prior to it taking place to add to the fidelity and rigour of the trial process and outcomes. Our goal is to adapt STEPS to optimise its benefits in future applications. METHODS In line with the Medical Research Council guidelines for evaluating complex interventions, the process evaluation will adopt a mixed method design using qualitative data collected from clinicians and parent interviews and app usage data from participants assigned to the intervention arm. ANALYSIS Qualitative data from semistructured interviews and free text box responses included in trial questionnaires will be analysed thematically using framework analysis to better understand how parents use STEPS, how it works and key factors that could aid or hinder its effective implementation in routine clinical practice. ETHICS The application for ethical approval for the study was submitted to the North West-Liverpool Central Research Ethics Committee and received a favourable opinion on further information on 26 November 2021, reference number 21/NW/0319. DISSEMINATION The process evaluation aims to explore how a digital app might support parents in managing their child's behaviour. Implications for policy and research will be explored and the clinical implications of offering the app to a wider audience to address the lack of support to parents as highlighted in this paper. We plan to publish findings in international, peer-reviewed journals as well as present at conferences. TRIAL REGISTRATION NUMBER The trial has been prospectively registered on 18 November 2021; ISRCTN816523503. https://www.isrctn.com/ISRCTN16523503.
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Affiliation(s)
- Ellen Hedstrom
- Centre for Innovation of Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Katarzyna Kostyrka-Allchorne
- Department of Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Blandine French
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Charlotte Lucy Hall
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Hanna Kovshoff
- Centre for Innovation of Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Nancy Lean
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edmund Sonuga-Barke
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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14
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Corberán M, Arnáez S, Saman Y, Pascual-Vera B, García-Soriano G, Roncero M. Cognitive training via mobile app for addressing eating disorders' cognitions in adolescents: a randomized control trial protocol. BMC Psychol 2024; 12:268. [PMID: 38745260 PMCID: PMC11092152 DOI: 10.1186/s40359-024-01772-z] [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: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
During adolescence, individuals are particularly vulnerable to developing eating disorders (EDs). To address the dysfunctional beliefs linked to these disorders, a new mobile app has been developed. This app, called GG eating disorders-Adolescents (GGED-AD), was created based on CBT to help adolescents work on their self-dialogue related to the core beliefs of eating disorders. The objective is to present the protocol for a randomized controlled trial to explore the efficacy of GGED-AD.Methods The study will be carried out in adolescents aged 13 to 16 from an educational center in the Valencian Community. The participants will be randomized into two groups: the experimental group will use the GGED-AD app during 14 consecutive days for approximately 5 min each day; and the control group will use a neutral app (GGNEUTRAL) during the same time. Both groups will complete instruments that assess dysfunctional beliefs related to eating disorders, eating symptoms, symptoms of depression and anxiety, body satisfaction and self-esteem before and after the intervention. A follow-up will be conducted one month later.Results A decrease in the degree of ascription to dysfunctional beliefs associated with eating disorders and eating symptomatology is expected, as well as an increase in body satisfaction and the self-esteem of the participants of the experimental group.Discussion The app in this study could help tackle and prevent ED-related symptoms in adolescents.Trial registration NCT06039514.
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Affiliation(s)
- Marta Corberán
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Sandra Arnáez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Yuliya Saman
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Belén Pascual-Vera
- Departamento Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, UNED, C/Juan Rosal, 10, Madrid, 28040, Spain
| | - Gemma García-Soriano
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain.
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15
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Effects of Youth Flexible Assertive Community Treatment: outcomes of an 18-month observational study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:745-758. [PMID: 37280465 PMCID: PMC11087363 DOI: 10.1007/s00127-023-02508-x] [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: 11/20/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE This Multicenter Youth Flexible ACT Study examined the effect of Youth Flexible Assertive Community Treatment on symptomatic, social, and personal recovery outcomes of adolescents dealing with multifaceted psychiatric and social care needs who do not readily engage in regular office-based mental health services. METHODS Newly admitted clients (n = 199) aged 12-24 years from 16 Youth Flexible ACT teams participated in this observational prospective cohort study. Client and practitioner questionnaires were administered every 6 months, up to 18 months. Latent growth curve analyses were conducted to examine changes in symptomatic, social, and personal recovery outcomes throughout Flexible ACT. RESULTS Our analyses of client-reported outcomes showed a decrease in overall psychosocial difficulties, depressive symptoms, and subclinical psychosis symptoms. Moreover, outcomes showed improved social interaction with peers, quality of life, and feelings of empowerment and fewer contacts with the police/legal system. In addition, analyses of clinician-reported outcomes showed a decrease in problems related to family life, peer relationships, school/work attendance, emotional symptoms, and attentional problems. Problems related to personal finance, school and work status, substance misuse, disruptive and aggressive behavior, self-injury, and self-care and independence remained unchanged. CONCLUSION Our results showed that clients participating in Youth Flexible ACT improved in symptomatic, social, and personal recovery outcomes over 18 months. With its integrated approach and personalized care, this service delivery model is promising for adolescents unable to engage successfully in regular (office based) mental health support services.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands.
- Tranzo-Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | | | | | | | - Hans Kroon
- Tranzo-Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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16
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Mathews F, Benham-Clarke S, Ford TJ, Hill S, Sadler K, Newlove-Delgado T. Experiences of help-seeking from professional services for a child or young person's mental health concerns during the pandemic: A qualitative study. PLoS One 2024; 19:e0297417. [PMID: 38626031 PMCID: PMC11020827 DOI: 10.1371/journal.pone.0297417] [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: 07/18/2023] [Accepted: 01/04/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION The immediate response to the Covid-19 pandemic saw school closures and a shift in provision to online health services for children and young people experiencing mental health concerns. This study provides mental health and referral services with an insight into difficulties experienced as well as recommendations on potential improvements. METHODS Semi-structured interviews with 11 parents and six young people. Reflexive thematic analysis was used to analyse the data. RESULTS Parents and young people reported mixed experiences on accessing mental health support. Priorities and pressures on health services impacted the likelihood of choosing to seek and being able to obtain help. Parents and young people had varying expectations and experiences in help-seeking during the pandemic which were also impacted by others' experiences and views. For many, the relationship with the professional they were in contact with impacted their mental health treatment. Provision was sometimes accessed via private services due to long waiting lists or problems that did not "meet threshold". CONCLUSION Understanding the experiences of seeking mental healthcare during the pandemic can inform improvements to access to services at a time when people are most vulnerable. Accessible provision other than private services needs to be made for those on waiting lists. For those who do not meet service threshold, intermediary support needs to be secured to prevent unnecessary exacerbation of symptoms and prolonged problems. If schools are to remain the hub for children and young people's mental health services, they should be considered essential services at all times.
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Affiliation(s)
| | | | - Tamsin J. Ford
- Developmental Psychiatry, University of Cambridge, Cambridge, United Kingdom
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17
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Lester KJ, Michelson D. Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context. BMJ MENTAL HEALTH 2024; 27:e300944. [PMID: 38580437 PMCID: PMC11021743 DOI: 10.1136/bmjment-2023-300944] [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: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 04/07/2024]
Abstract
School absences have risen following the COVID-19 pandemic and persistent absenteeism remains high in primary and secondary schools in England compared with pre-pandemic levels. This coincides with an upward trend in emotionally based school avoidance (EBSA). EBSA adversely affects children's educational attainment, health, social functioning and life prospects and warrants early intervention before a pattern of absenteeism becomes entrenched. In this article, we consider how the COVID-19 pandemic and its sequelae have created a 'perfect storm' of conditions, amplifying known school, family and child-based risk factors for EBSA while simultaneously reducing access to support services. We then outline priorities for developing new EBSA interventions and argue for a multi-component approach, which works across education, health and social care, and voluntary sectors to address the complex interplay between risk factors. Given the difficulties that families often face in obtaining timely support for EBSA, it is also essential that new interventions are accessible, resource-efficient and scalable. To this end, we specifically discuss the potential for contextually-sensitive, parent-focused interventions that can be delivered online with minimal synchronous support from a trained coach or facilitator.
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Affiliation(s)
- Kathryn J Lester
- School of Psychology, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, UK
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18
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Treier AK, Hautmann C, Dose C, Nordmann L, Katzmann J, Pinior J, Scholz KK, Döpfner M. Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior. Child Psychiatry Hum Dev 2024; 55:453-466. [PMID: 36064990 PMCID: PMC9444695 DOI: 10.1007/s10578-022-01400-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
The study examined potential mediating effects of therapist behaviors in the per-protocol sample (n = 108) of a randomized controlled trial comparing a behavioral and a nondirective guided self-help intervention for parents of children with externalizing disorders (4-11 years). Additionally, from an exploratory perspective, we analyzed a sequential model with parental adherence as second mediator following therapist behavior. Outcomes were child symptom severity of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder rated by blinded clinicians, and parent-rated child functional impairment. We found a significant indirect effect on the reduction of ADHD and functional impairment through emotion- and relationship-focused therapist behavior in the nondirective intervention. Additionally, we found limited support for an extended sequential mediation effect through therapist behavior and parental adherence in the models for these outcomes. The study proposes potential mediating mechanisms unique to the nondirective intervention and complements previous findings on mediator processes in favor of the behavioral group. Trial registration ClinicalTrials.gov NCT01350986.
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Affiliation(s)
- Anne-Katrin Treier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany.
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Nordmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Josepha Katzmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Julia Pinior
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kristin Katharina Scholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
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19
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Stevenson B, Bolton T, Dare N. Focus Group With Parents of Children With Mental and Behavioral Health Concerns. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:187-195. [PMID: 37737010 DOI: 10.1177/15394492231200904] [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] [Indexed: 09/23/2023]
Abstract
BACKGROUND Scholars from multiple fields have shown that parents raising a child with mental and behavioral health concerns (MBHC) need additional support. We need parents to self-identify necessary supports as a basis for intervention planning. OBJECTIVES In this study, we examined what parents say they need from professionals to support their families. METHODOLOGY Occupational therapy faculty and students employed a strengths-based coaching approach to conduct a focus group with five parents. We conducted qualitative thematic analysis and used inductive coding to identify themes related to unmet self-identified needs of families. We refined themes through an iterative process and achieved 93% agreement after three rounds of coding. RESULTS Four themes emerged from the transcript analysis: External Control, Internal Competence, Relating to Others, and Role of Self-Care. CONCLUSION Professionals must consider the unique needs identified by parents who have children with MBHC when planning interventions within our education and health care systems.
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20
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Senior M, Pierce M, Taxiarchi VP, Garg S, Edge D, Newlove-Delgado T, Neufeld SAS, Abel KM. 5-year mental health outcomes for children and adolescents presenting with psychiatric symptoms to general practitioners in England: a retrospective cohort study. Lancet Psychiatry 2024; 11:274-284. [PMID: 38490760 DOI: 10.1016/s2215-0366(24)00038-5] [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: 11/26/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses. METHODS In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3-18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress. FINDINGS We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4-16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000-2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio vs low-contact group 2·19 [95% CI 2·03-2·36]) and suicide (2·67 [1·72-4·14]). INTERPRETATION Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents. FUNDING National Institute for Health and Care Research and the Wellcome Trust.
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Affiliation(s)
- Morwenna Senior
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK.
| | - Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Shruti Garg
- Division of Neuroscience, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK; Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | | | | | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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An R. RETRACTED ARTICLE: Analysis of Factors Affecting Mental Health in College English Teaching Courses. J Autism Dev Disord 2024; 54:1619. [PMID: 37592060 DOI: 10.1007/s10803-023-06087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Ran An
- School of Foreign Languages, Weifang University, Weifang, 261061, Shandong, China.
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22
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Hense H, Ernst S, Zscheppang A, Schmitt J, Roessner V, Weniger M, Beesdo-Baum K, Knappe S. [Implementation of a novel form of care for the early detection and prevention of emotional and behavioral problems in children in the pediatric setting: Qualitative interviews with pediatricians, practice staff and parents]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 185:92-107. [PMID: 38503633 DOI: 10.1016/j.zefq.2023.12.004] [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: 02/06/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 03/21/2024]
Abstract
AIM OF THE STUDY Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and/or to further counselling and treatment services. METHODS 1.) Semi-structured interviews were performed with participating pediatricians (n=4), practice staff (n=4) and custodians of screened children (n=17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n=34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services. RESULTS In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families' use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n=11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians "completely" or "rather" agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care. DISCUSSION The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services. CONCLUSION An adoption of the novel form of care (SDQ screening and targeted allocation to indicated preventive programs and further services) to standard pediatric care unfolds its benefits if preventive and care services for EBPs in children are made available nationwide.
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Affiliation(s)
- Helene Hense
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
| | - Sophia Ernst
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Anja Zscheppang
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Technische Universität Dresden, Dresden, Deutschland
| | - Max Weniger
- Behaviorale Epidemiologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
| | - Katja Beesdo-Baum
- Behaviorale Epidemiologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
| | - Susanne Knappe
- Behaviorale Epidemiologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
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Santillanes G, Foster AA, Ishimine P, Berg K, Cheng T, Deitrich A, Heniff M, Hooley G, Pulcini C, Ruttan T, Sorrentino A, Waseem M, Saidinejad M. Management of youth with suicidal ideation: Challenges and best practices for emergency departments. J Am Coll Emerg Physicians Open 2024; 5:e13141. [PMID: 38571489 PMCID: PMC10989674 DOI: 10.1002/emp2.13141] [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: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine of USCLos Angeles General Medical CenterLos AngelesCaliforniaUSA
| | - Ashley A. Foster
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Paul Ishimine
- Departments of Emergency Medicine and PediatricsUniversity of California, San Diego School of Medicine, UC San Diego Health and Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Kathleen Berg
- Department of Pediatrics, Dell Medical SchoolThe University of TexasAustinTexasUSA
| | - Tabitha Cheng
- Department of Emergency MedicineHarbor UCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Ann Deitrich
- Division Chief Pediatric Emergency MedicineDepartment of Emergency MedicinePrisma HealthUniversity of South Carolina School of MedicineGreenvilleSouth CarolinaUSA
| | - Melanie Heniff
- Departments of Emergency Medicine and PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gwen Hooley
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Christian Pulcini
- Department of Emergency Medicine and PediatricsUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Timothy Ruttan
- Department of PediatricsDell Medical SchoolThe University of Texas at Austin. US Acute Care SolutionsCantonOhioUSA
| | - Annalise Sorrentino
- Department of Pediatrics, Division of Emergency MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Muhammad Waseem
- Lincoln Medical Center, Bronx New York; Weill Cornell MedicineNew YorkUSA
| | - Mohsen Saidinejad
- Departments of Emergency Medicine and PediatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
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Sawrikar V, Van Dyke C, Smith Slep AM. The Ws of Parental Help-Seeking: When, Where, and for What Do Parents Seek Help for Child Mental Health. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01683-5. [PMID: 38507021 DOI: 10.1007/s10578-024-01683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
Parental help-seeking preferences may help explain the treatment gap in child mental health. This study examined mothers' and fathers' help-seeking behaviors for child mental health to further understand their individual preferences for treatment. A total of 394 mothers and fathers completed questionnaires assessing the types of help sought for mental health concerns for a target child (age 3-7 years), as well as measures representing illness profile, predisposing characteristics, and barriers/facilitators proposed to influence help-seeking. Parents often sought informal rather than professional help. Regression modelling indicated mothers' different help-seeking behaviors were significantly associated with illness profile (marital quality, child mental health, parental education), predisposing factors (parental attributions, child age), and family income, while fathers' different help-seeking behaviors were significantly associated with child demographics (age, gender). The results support expanding treatments into nonclinical settings and improving child mental health literacy to improve appropriate parental help-seeking for child mental health concerns.
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Affiliation(s)
- Vilas Sawrikar
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK.
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK.
| | | | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY, USA
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25
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Kabembo IM. Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia. Front Public Health 2024; 12:1250608. [PMID: 38525347 PMCID: PMC10959020 DOI: 10.3389/fpubh.2024.1250608] [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: 06/30/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Methods Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Results Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. Conclusion These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.
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Affiliation(s)
- Ireen Manase Kabembo
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, Hong Kong SAR, China
- Department of Social Work and Sociology, University of Zambia, Lusaka, Zambia
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26
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Kusaka S, Foo JC, Yamaguchi S, Yukawa A, Arai T, Sawamura F, Togo F, Sasaki T. A survey of mental health literacy in parents and guardians of teenagers. Front Psychiatry 2024; 15:1295918. [PMID: 38404469 PMCID: PMC10884296 DOI: 10.3389/fpsyt.2024.1295918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers. Methods Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors). Results The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively. Conclusions Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.
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Affiliation(s)
- Sakurako Kusaka
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Jerome Clifford Foo
- Institute for Psychopharmacology, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Satoshi Yamaguchi
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ayuko Yukawa
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Takuya Arai
- Saitama Prefectural Education Bureau Student Consultation Division, Saitama, Japan
| | - Fumika Sawamura
- Saitama Prefectural Education Bureau Health and Physical Education Division, Saitama, Japan
| | - Fumiharu Togo
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
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Moreira H, Skvarc D, Gomes-Pereira B, Albuquerque A, Góis AC, Fonseca A, Pereira AM, Caiado B, Paulino B, Santos C, Ehrenreich-May J, Canavarro MC, Saraiva M, Vicente VN, Pereira AI. Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children. BMC Psychol 2024; 12:63. [PMID: 38326847 PMCID: PMC10851582 DOI: 10.1186/s40359-024-01532-z] [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: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).
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Affiliation(s)
- Helena Moreira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal.
| | - Dave Skvarc
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Bárbara Gomes-Pereira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | | | - Ana Carolina Góis
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Maria Pereira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Brígida Caiado
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
- Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Bruna Paulino
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Santos
- Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Mariana Saraiva
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Vitória Nunes Vicente
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Isabel Pereira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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28
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Darcy L, Råberus A, Sundler AJ. A qualitative analysis of child and family complaints related to child mental health services. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12436. [PMID: 37443353 DOI: 10.1111/jcap.12436] [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: 08/24/2022] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
PROBLEM Little is known about issues of patient-reported problems, in particular within psychiatric services for children with mental ill health. Child and family complaints related to child mental health services can be analyzed and discussed in light of the universal human right to health and healthcare. Therefore, the aim of this study was to analyze child and family complaints related to child mental health services. METHODS A retrospective, descriptive design was used. Child and family complaints were analyzed with a qualitative thematic analysis. FINDINGS The findings were described in three themes describing lack of access to care, inadequate communication between services and children with mental ill health and their families, and lack of clarity of who is responsible for care, leading to neglect of children's needs. These issues place a huge responsibility on parents or relatives. CONCLUSION Better communication within mental health services, and better collaboration with other services such as school and social services, could limit children's suffering. Healthcare services with named professionals who specialize in child mental health and provide continuity in care, are required. General human rights principles should guide planning and care of children.
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Affiliation(s)
- Laura Darcy
- Insitution for Caring Science, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Boras, Sweden
| | - Anna Råberus
- Division of Psychiatry, Södra Älvsborg Hospital, Borås, Sweden
| | - Annelie J Sundler
- Insitution for Caring Science, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Boras, Sweden
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29
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Mora Ringle VA, Sung JY, Roulston CA, Schleider JL. Mixed-Methods Examination of Adolescent-Reported Barriers to Accessing Mental Health Services. J Adolesc Health 2024; 74:268-276. [PMID: 37804301 PMCID: PMC10842491 DOI: 10.1016/j.jadohealth.2023.08.034] [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: 12/20/2022] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Many adolescents struggle to access the mental healthcare they need. To increase access to mental health services, we must have a clear understanding of the barriers adolescents face from their own perspectives. This online mixed-methods study aimed to enhance understanding of access barriers by centering the perspectives of diverse adolescents who had recently tried and failed to access mental health support. METHODS In this convergent parallel mixed-methods study, adolescents responded to a preintervention, open-ended question about barriers they have faced to accessing mental health services when they needed them and shared information about their background and depressive symptoms. Barriers were assessed using inductive, conventional content analysis. Quantitative analyses examined barrier differences across sociodemographic groups. RESULTS All adolescents (aged 11-17 years, 50% racially minoritized youth, 15% gender diverse youth, 64% LGBTQ + youth; 78% with clinically elevated depressive symptoms) reported at least one barrier to accessing mental health support, and 20% reported multiple barriers. Content analysis revealed 13 barrier categories, with parent-related barriers (three different categories) accounting for 32% of all barriers. The most common barrier categories related to personal and financial constraints. Asian adolescents, adolescents who were aged 17 years or more, and adolescents who reported uncertainty of their gender identity endorsed the numerically highest mean number of barriers to accessing mental health support. DISCUSSION High-symptom adolescents reported myriad barriers to accessing mental health support, with 32% of all barriers related to parents.
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Affiliation(s)
- Vanesa A Mora Ringle
- Counseling Psychology Program, Department of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania.
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Chantelle A Roulston
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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30
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Tan RHS, Koh YS, Vaingankar JA, Abdin E, Sambasivam R, Chong SA, Subramaniam M. Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 2024; 59:375-383. [PMID: 36786835 DOI: 10.1007/s00127-023-02440-0] [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: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Although the trajectory of mental disorders can be improved with timely treatment, many people defer treatment-seeking. This study aimed to examine the prevalence and correlates of treatment delays for mental disorders in Singapore, as well as perceived effectiveness of treatment received. METHODS A total of 6126 respondents, aged 18 and above, participated in the Singapore Mental Health Study 2016-a cross-sectional, nationwide study conducted in Singapore from 2016 to 2018. Lifetime treatment contact for mood, anxiety, and alcohol use disorders (AUD) was assessed using the World Mental Health-Composite International Diagnostic Interview (Version 3.0). Multivariable logistic regression was conducted to examine correlates of delayed treatment. RESULTS A total of 137 participants had made lifetime treatment contact for a mental disorder. The proportion of respondents who received delayed treatment (i.e., at least one year after onset of disorder) was 60.8% for any disorder, 59.5% for mood disorders, 56.3% for anxiety disorders, and 92.7% for AUD. The median delay was 5 years for mood disorders, one year for anxiety disorders, and 4 years for AUD. Treatment delay was significantly associated with older age, higher educational qualification, lifetime AUD, and earlier age of onset of disorder. 58.4% of respondents with lifetime treatment contact had received treatment that they considered effective. CONCLUSION The high prevalence and long durations of treatment delay underscore the need to encourage help-seeking for mental disorders, especially since treatment is generally perceived to be helpful. Our findings also highlight several population groups more susceptible to receiving delayed treatment.
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Affiliation(s)
- Rachel Hsiao Shen Tan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Yen Sin Koh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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Wickens N, van Rensburg EJ, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Woolard A. "It's a big trauma for the family": A qualitative insight into the psychological trauma of paediatric burns from the perspective of mothers. Burns 2024; 50:262-274. [PMID: 37821283 DOI: 10.1016/j.burns.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Despite the medical and surgical improvements of paediatric burn injuries, burn injuries can be a painful and traumatic experience for the child and their family. It is therefore important to explore the experiences of caregivers who support their child throughout the burn journey. Thus, the purpose of this study was to explore the traumatic nature of paediatric burns on the family from a caregiver's perspective. METHODS This study used a descriptive qualitative approach to conduct online semi-structured interviews with caregivers (18 years and older) of children (aged four to 17 years) that had previously been admitted with an unintentional acute burn injury to a paediatric burns unit in Western Australia. Interviews explored the child's and caregiver's experiences throughout the burn journey from the perspective of the caregiver and were digitally recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke's six stages of reflexive thematic analysis. RESULTS Eleven mothers participated in the interviews and identified a range of poor psychological and psychosocial outcomes that themselves and their child experienced. Three overarching themes were elaborated from the interviews: Child and caregiver mental health difficulties during and after the burn (including medical trauma, mental health outcomes and caregiver guilt); Lifestyle and physical changes following the burn (including disruptions to routine, appearance concerns and puberty); and factors supporting or inhibiting the recovery journey (including personality factors, coping strategies, family dynamics and support). FINAL CONSIDERATIONS This study has presented the difficulties that children, young people, and their family face throughout a paediatric burn injury, which makes the implementation of timely and effective family centred interventions imperative. Meeting the needs and supporting these families with their mental health throughout this traumatic recovery journey, can ensure positive psychosocial outcomes and adaptive coping strategies are adopted early on.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia.
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia; The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | | | - Helen Milroy
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Lisa Martin
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Fiona Wood
- The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Burn Service of Western Australia, Perth Children's Hospital, Ward 1B, 15 Hospital Avenue, Nedlands, Australia; Fiona Wood Foundation, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia; The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Burch MM, Rossiter S, McGinty-Kolbe K, Fredwall M, Tschirner C, Enciso L, Iskander J, Trott K, Jackson K, Albert DVF. Multidisciplinary Care May Help to Reduce Disparities Associated With Race in Youth With Psychogenic Nonepileptic Seizures. Pediatr Neurol 2024; 151:29-33. [PMID: 38091920 DOI: 10.1016/j.pediatrneurol.2023.11.007] [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: 10/06/2022] [Revised: 05/03/2023] [Accepted: 11/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are a common type of functional neurological disorder in which patients experience seizurelike episodes. Health disparities based on race and socioeconomics, documented in children with epilepsy and adults with PNES, have not been reported in children and adolescents with PNES. We hypothesize that disparities exist in this population, which impact overall care and therefore influence outcomes. METHODS We retrospectively analyzed youth referred to our multidisciplinary clinic from 2018 to 2020. All patient charts were screened by social work before the visit to identify potential barriers to care, and a nurse conducted follow-up calls. Patients' race was identified from the electronic health record and compared with several variables. Outcomes were collected via phone follow-up. Descriptive statistics were produced, and comparisons between white patients and patients of other races were completed using Fisher exact tests and multivariable logistic regressions. RESULTS During the study period, 237 patients were eligible for the analysis. Sixty-eight patients (29%) identified as a race other than white. Only 60%, 56%, and 40% of the cohort were reached for follow-up at one, three, and 12 months, respectively. In general, outcomes were similar between racial groups; however, we found that patients of nonwhite race were more likely to receive support from social work due to barriers identified in screening (P = 0.045). CONCLUSIONS Health disparities based on race may exist in youth with PNES. A multidisciplinary clinic including social work may help mitigate barriers leading to more equitable care and similar outcomes for white and nonwhite youth with PNES.
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Affiliation(s)
- Maggie Mary Burch
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | | | - Katie McGinty-Kolbe
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Megan Fredwall
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Christy Tschirner
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Laurie Enciso
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Jeannette Iskander
- Akron Children's Hospital, NeuroDevelopmental Science Center at Akron Children's Hospital, Akron, Ohio
| | - Kristen Trott
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kenneth Jackson
- Department of Biomedical Informatics, College of Medicine, Center for Biostatistics, The Ohio State University, Columbus, Ohio; Nationwide Children's Hospital, Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, Ohio
| | - Dara V F Albert
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
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Kercher A, Beattie S, Donkin L, Shepherd D. Distress, waitlists and unmet needs: parents' reports of child psychological difficulties in Aotearoa New Zealand. Aust N Z J Public Health 2024; 48:100120. [PMID: 38215533 DOI: 10.1016/j.anzjph.2023.100120] [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: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Demand for children's mental health services has increased in New Zealand, yet little is known of young children's experience of psychological difficulties and treatment. This study investigated psychological symptoms and treatment experiences among primary-aged children. METHOD An online survey of parents assessed children's anxiety, depression, attentional, emotional, conduct and peer problems, and experiences seeking psychological treatment. RESULTS Based on 382 parental reports, between 24.9 and 34.6% of children experienced abnormal-range symptoms. Older children had higher distress, depression, and anxiety. Boys had more conduct, hyperactivity, and peer problems. Ethnicity was not associated with the incidence of symptoms, but parents of Pākeha/European children reported greater impact than Māori parents. One-third of children had been referred for assessment; more often older children, and those with higher hyperactivity, impact, and anxiety. Parents reported difficulties accessing assessment, common barriers included waitlists (53%), cost (43%), and not knowing who to contact (36%). Following intervention, only 51% of parents reported improvements. CONCLUSION NZ primary-aged children are experiencing more symptoms of psychological distress than previously reported and extensive difficulties accessing treatment. IMPLICATIONS FOR PUBLIC HEALTH There is a need for further screening and increased access to treatment to prevent worsening mental health outcomes in children.
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Affiliation(s)
- Amy Kercher
- Department of Psychology and Neuroscience, Auckland University of Technology, New Zealand.
| | - Seona Beattie
- Department of Psychology and Neuroscience, Auckland University of Technology, New Zealand
| | - Liesje Donkin
- Department of Psychology and Neuroscience, Auckland University of Technology, New Zealand
| | - Daniel Shepherd
- Department of Psychology and Neuroscience, Auckland University of Technology, New Zealand
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Mubeen Z, Fatmi Z, Hameed W, Asim M. Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives. BMC Health Serv Res 2024; 24:157. [PMID: 38302915 PMCID: PMC10832177 DOI: 10.1186/s12913-024-10593-0] [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: 07/13/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs). METHOD Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach. RESULT The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery. CONCLUSION Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.
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Affiliation(s)
- Zainab Mubeen
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Zafar Fatmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Population Research Center, University of Texas at Austin, Austin, TX, USA
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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:S0890-8567(24)00009-1. [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] [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). 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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Soneson E, White SR, Howarth E, Ford T, Fazel M, Jones PB. Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity. Epidemiol Psychiatr Sci 2024; 33:e1. [PMID: 38264958 PMCID: PMC7615639 DOI: 10.1017/s2045796024000027] [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: 06/19/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. METHODS We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). RESULTS Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91). CONCLUSIONS Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.
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Affiliation(s)
- E. Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - S. R. White
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - E. Howarth
- School of Psychology, University of Sussex, Brighton, UK
| | - T. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - M. Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Calear AL, Batterham PJ, McCallum SM, Banfield M, Moore E, Johnson N, Morse AR. Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study. JMIR Form Res 2024; 8:e48945. [PMID: 38236625 PMCID: PMC10835581 DOI: 10.2196/48945] [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: 05/12/2023] [Revised: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. OBJECTIVE This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. METHODS A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. RESULTS A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. CONCLUSIONS This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
- ALIVE National Centre for Mental Health Research Translation, Melbourne, Australia
| | - Elizabeth Moore
- Office for Mental Health and Wellbeing, ACT Health, Canberra, Australia
| | - Natalie Johnson
- Office for Mental Health and Wellbeing, ACT Health, Canberra, Australia
| | - Alyssa R Morse
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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Iglhaut L, Primbs R, Kaubisch S, Koppenhöfer C, Piechaczek CE, Keim PM, Kloek M, Feldmann L, Schulte-Körne G, Greimel E. Evaluation of a web-based information platform on youth depression and mental health in parents of adolescents with a history of depression. Child Adolesc Psychiatry Ment Health 2024; 18:7. [PMID: 38218899 PMCID: PMC10787406 DOI: 10.1186/s13034-023-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
Research shows the important role of parents' mental health literacy in detecting depressive symptoms and supporting their children to seek professional help. Improving mental health literacy in parents has recently gained even greater importance due to the negative impact of the COVID-19 pandemic on children and adolescents' mental health. The aim of the present experimental pre-post-follow-up study was to examine knowledge change after the reception of contents from an innovative web-based platform ( www.ich-bin-alles.de/eltern ) containing evidence-based information on youth depression and mental health in parents of adolescents with a history of depression. A second aim was to assess evaluation of the layout and the acceptance of the platform. N = 33 parents of adolescents with a history of depression (either current or remitted depression) were presented different content domains of the website. Participants' knowledge about depression was assessed at pre- and post-intervention, and at a four week follow-up. Moreover, parents evaluated the acceptance and the layout of the website. The trial was preregistered at clinicaltrials.gov (NCT05335564). The results showed a significant increase in total knowledge from pre to post, which remained stable over the course of four weeks. Explorative analyses showed that sociodemographic variables did not influence the extent of knowledge gain. Acceptance rates were high and evaluations of the website's layout were positive. The findings show that the web-based information portal is a promising and appealing means to increase parental knowledge on youth depression. Low-threshold psychoeducational approaches like websites are particularly relevant in times of crisis and increased prevalence rates of depressive symptoms and disorders (ehealth). These results are an important basis for future studies as well as approaches that aim to impart knowledge about mental disorders like youth depression via web-based means. Furthermore, they bear implications for policy decisions concerning mental health education and campaigns.
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Affiliation(s)
- Lucia Iglhaut
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany.
| | - Regine Primbs
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Sara Kaubisch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Chiara Koppenhöfer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Charlotte E Piechaczek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Pia-Marie Keim
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Maria Kloek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Lisa Feldmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
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McLellan LF, Woon S, Hudson JL, Lyneham HJ, Karin E, Rapee RM. Treating child anxiety using family-based internet delivered cognitive behavior therapy with brief therapist guidance: A randomized controlled trial. J Anxiety Disord 2024; 101:102802. [PMID: 38071870 DOI: 10.1016/j.janxdis.2023.102802] [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: 03/08/2023] [Revised: 11/04/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7-12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au; ACTRN12615000947505.
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Affiliation(s)
- Lauren F McLellan
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Samantha Woon
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia; School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jennifer L Hudson
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia; School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Heidi J Lyneham
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Ronald M Rapee
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
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Panagi L, White SR, Howdle C, Bennett S, Heyman I, Shafran R, Ford T. Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study. Eur Child Adolesc Psychiatry 2024; 33:21-31. [PMID: 36357554 PMCID: PMC10807016 DOI: 10.1007/s00787-022-02105-4] [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: 03/30/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.
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Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Charlotte Howdle
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
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Averill SH, McQuillan ME, Slaven JE, Weist AD, Kloepfer KM, Krupp NL. Assessment and management of anxiety and depression in a pediatric high-risk asthma clinic. Pediatr Pulmonol 2024; 59:137-145. [PMID: 37861359 DOI: 10.1002/ppul.26727] [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: 03/21/2023] [Revised: 08/22/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The aims of this study were to determine the prevalence of positive mental health (MH) screens in a pediatric high-risk asthma (HRA) clinic population, and to determine the success rate of engagement in MH services before and after adding a clinical psychologist to our multidisciplinary clinic. HYPOTHESIS We hypothesized that the HRA population would have a higher prevalence of anxiety/depression symptoms than that previously reported for the general pediatric asthma population. We anticipated that the presence of an embedded psychologist in HRA clinic would facilitate successful connection to MH services. METHODS Pediatric patients in the HRA clinic were prospectively screened for anxiety and depression using validated screening instruments. Positive scores were referred for MH services. Time to MH service engagement was recorded before and after the addition of a clinical psychologist. RESULTS A total of 186 patients were screened; 60% had a positive MH screen. Female sex was associated with higher median scores on both screening tools and higher likelihood of engagement in MH services. After addition of a clinical psychologist, new engagement in MH services increased (20% vs. 80%, p < 0.0001), and median time to engagement decreased (14.5 vs. 0.0 months, p = 0.003). CONCLUSION There is a high prevalence of anxiety and depression in this pediatric HRA population. Success of engagement in MH services improved after a clinical psychologist joined our multidisciplinary team, suggesting access to care as a primary barrier to engagement.
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Affiliation(s)
- Samantha H Averill
- Department of Pediatrics, Division of Pulmonary, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea D Weist
- Department of Pediatrics, Division of Pulmonary, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kirsten M Kloepfer
- Department of Pediatrics, Division of Pulmonary, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nadia L Krupp
- Department of Pediatrics, Division of Pulmonary, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Peskin A, Barth A, Andrew Rothenberg W, Turzi A, Formoso D, Garcia D, Jent J. New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy. Behav Ther 2024; 55:106-121. [PMID: 38216225 DOI: 10.1016/j.beth.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 01/14/2024]
Abstract
Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [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] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Hagen MH, Hartvigsen G, Jaccheri L, Papavlasopoulou S. Digital Psychosocial Follow-up for Childhood Critical Illness Survivors: A Qualitative Interview Study on Health Professionals' Perspectives. Scand J Child Adolesc Psychiatr Psychol 2024; 12:50-62. [PMID: 39027413 PMCID: PMC11255782 DOI: 10.2478/sjcapp-2024-0006] [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] [Indexed: 07/20/2024] Open
Abstract
Background Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects. Objective To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors. Methods Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed. Results The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors. Conclusions Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.
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Affiliation(s)
- Marte Hoff Hagen
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnar Hartvigsen
- Department of Computer Science, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
| | - Letizia Jaccheri
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sofia Papavlasopoulou
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
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Chatrath S, LeBovidge J, Jack C, Abuabara K, Schneider LC, Capozza K, Kelley K, Silverberg JI. Mental health interventions for atopic dermatitis: knowledge gaps, pilot programmes and future directions. Clin Exp Dermatol 2023; 49:9-17. [PMID: 37706273 DOI: 10.1093/ced/llad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD.
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Affiliation(s)
| | - Jennifer LeBovidge
- Boston Children's Hospital, Boston MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carolyn Jack
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, USA
| | - Keri Kelley
- Global Parents for Eczema Research, Santa Barbara, CA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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46
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Moreira H, Góis AC, Pereira AM, Pereira B, Caiado B, Nepomuceno MI, Pereira AI. Parents' acceptability of blended psychological interventions for children with emotional disorders. Internet Interv 2023; 34:100687. [PMID: 38023966 PMCID: PMC10654020 DOI: 10.1016/j.invent.2023.100687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study aims to (1) describe parents' knowledge and use of online resources to address children's mental health issues and the family's general internet and technology usage patterns; (2) examine parents' acceptance of blended interventions for children with emotional disorders (ED); and (3) analyse the predictors of parents' intention to use a blended intervention if their children experienced an ED. Method The sample included 164 Portuguese parents (95.7 % mothers) of children between the ages of 6 and 13 years who completed an online survey. The study was disseminated through social networks, personal contacts of the researchers, and among parents participating in a randomized controlled trial investigating the efficacy of a psychological intervention for children with ED. Results Only 4.3 % of parents knew about online psychological interventions for children, and only 1.2 % had used them before. Most parents (73.2 %) reported that they would choose face-to-face individual therapy as their first option if their child had any ED, followed by blended therapy (14.8 %). Regression analyses showed that higher levels of parents' intention to use a blended intervention were predicted by their perceptions of the utility or efficacy of this type of delivery format. Discussion/conclusion These results suggest that although most parents show unfamiliarity with blended psychological interventions for children, they consider it a treatment modality to which they would resort if their children had emotional difficulties. Their intention to use such an intervention seems to be more likely if they perceive it as useful and effective.
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Affiliation(s)
- Helena Moreira
- University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Interventions, Faculty of Psychology and Educational Sciences, Portugal
| | - Ana Carolina Góis
- University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Interventions, Faculty of Psychology and Educational Sciences, Portugal
| | - Ana Maria Pereira
- University of Coimbra, Faculty of Psychology and Educational Sciences, Portugal
| | - Bárbara Pereira
- University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Interventions, Faculty of Psychology and Educational Sciences, Portugal
| | - Brígida Caiado
- University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Interventions, Faculty of Psychology and Educational Sciences, Portugal
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Cunningham PB, Gilmore J, Naar S, Preston SD, Eubanks CF, Hubig NC, McClendon J, Ghosh S, Ryan-Pettes S. Opening the Black Box of Family-Based Treatments: An Artificial Intelligence Framework to Examine Therapeutic Alliance and Therapist Empathy. Clin Child Fam Psychol Rev 2023; 26:975-993. [PMID: 37676364 PMCID: PMC10845126 DOI: 10.1007/s10567-023-00451-6] [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: 08/15/2023] [Indexed: 09/08/2023]
Abstract
The evidence-based treatment (EBT) movement has primarily focused on core intervention content or treatment fidelity and has largely ignored practitioner skills to manage interpersonal process issues that emerge during treatment, especially with difficult-to-treat adolescents (delinquent, substance-using, medical non-adherence) and those of color. A chief complaint of "real world" practitioners about manualized treatments is the lack of correspondence between following a manual and managing microsocial interpersonal processes (e.g. negative affect) that arise in treating "real world clients." Although family-based EBTs share core similarities (e.g. focus on family interactions, emphasis on practitioner engagement, family involvement), most of these treatments do not have an evidence base regarding common implementation and treatment process problems that practitioners experience in delivering particular models, especially in mid-treatment when demands on families to change their behavior is greatest in treatment - a lack that characterizes the field as a whole. Failure to effectively address common interpersonal processes with difficult-to-treat families likely undermines treatment fidelity and sustained use of EBTs, treatment outcome, and contributes to treatment dropout and treatment nonadherence. Recent advancements in wearables, sensing technologies, multivariate time-series analyses, and machine learning allow scientists to make significant advancements in the study of psychotherapy processes by looking "under the skin" of the provider-client interpersonal interactions that define therapeutic alliance, empathy, and empathic accuracy, along with the predictive validity of these therapy processes (therapeutic alliance, therapist empathy) to treatment outcome. Moreover, assessment of these processes can be extended to develop procedures for training providers to manage difficult interpersonal processes while maintaining a physiological profile that is consistent with astute skills in psychotherapeutic processes. This paper argues for opening the "black box" of therapy to advance the science of evidence-based psychotherapy by examining the clinical interior of evidence-based treatments to develop the next generation of audit- and feedback- (i.e., systemic review of professional performance) supervision systems.
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Affiliation(s)
- Phillippe B Cunningham
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Rd. Ste. 104, Charleston, SC, 29407, USA.
| | - Jordon Gilmore
- Department of Bioengineering, Clemson University, 401-3 Rhodes Research Center, Clemson, SC, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, USA
| | - Stephanie D Preston
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | - Catherine F Eubanks
- Gordon F. Derner School of Psychology, Adelphi University, One South Avenue, Garden City, NY, USA
| | - Nina Christina Hubig
- School of Computing, Clemson University, 1240 Supply Street, Charleston, SC, 29405, USA
| | - Jerome McClendon
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science & Coordinating Center for Clinical Trials (CCCT), University of Texas School of Public Health, University Texas Health Sciences , RAS W-928, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Stacy Ryan-Pettes
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798, USA
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Miller I, Peake E, Strauss G, Vierra E, Koepsell X, Shalchi B, Padmanabhan A, Lake J. Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study. JMIR Form Res 2023; 7:e43260. [PMID: 37991839 DOI: 10.2196/43260] [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: 10/06/2022] [Revised: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited. OBJECTIVE This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents. METHODS A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8. RESULTS The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program's ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points. CONCLUSIONS The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681.
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Affiliation(s)
- Ian Miller
- Limbix Health, Inc, San Francisco, CA, United States
| | - Emily Peake
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | | | - Elise Vierra
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Xin Koepsell
- Limbix Health, Inc, San Francisco, CA, United States
| | | | - Aarthi Padmanabhan
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Jessica Lake
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
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Flores MW, Sharp A, Carson NJ, Cook BL. Estimates of Major Depressive Disorder and Treatment Among Adolescents by Race and Ethnicity. JAMA Pediatr 2023; 177:1215-1223. [PMID: 37812424 PMCID: PMC10562990 DOI: 10.1001/jamapediatrics.2023.3996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/08/2023] [Indexed: 10/10/2023]
Abstract
Importance The COVID-19 pandemic has contributed to poorer mental health and a greater need for treatment. Nationally representative estimates of major depressive disorder (MDD) and mental health treatment among US adolescents during the pandemic are needed. Objective To estimate MDD prevalence among adolescents, evaluate mental health treatment use among adolescents with MDD, and assess differences by race and ethnicity. Design, Setting, and Participants This cross-sectional analysis of the nationally representative 2021 National Survey on Drug Use and Health included noninstitutionalized US adolescents between the ages of 12 and 17 years (n = 10 743). Analytic weights were applied to all rates and model estimates to be nationally representative and account for sample design and survey nonresponse. Data were collected from January 14 to December 20, 2021, and analyzed from February 11 to April 3, 2023. Exposures Self-reported race and ethnicity. Main Outcomes and Measures Dichotomous outcomes of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), MDD-specific mental health treatment, any type of mental health treatment, telehealth visits, and delays in mental health treatment. Results The sample included 10 743 adolescents (51.1% male). Self-reported race and ethnicity included 5.1% Asian, 14.1% Black, 23.3% Latinx, 51.2% White, and 6.3% more than 1 race. Ages were evenly distributed: 34.0% aged 12 to 13 years; 33.3% aged 14 to 15 years; and 32.7% aged 16 to 17 years. Adolescents of more than 1 race or ethnicity had the highest MDD rate (26.5%). Compared with White adolescents, the lowest rates of any MDD treatment overall were found among Latinx adolescents (29.2% [95% CI, 22.2%-36.2%]) and those of more than 1 race or ethnicity (21.1% [95% CI, 11.6%-30.7%]). Similar results were found for treatment by any clinician (Latinx, 25.6% [95% CI, 18.8%-32.4%]; >1 race or ethnicity, 19.1% [95% CI, 9.7%-28.6%]), treatment by a mental health specialist (Latinx, 22.9% [95% CI, 16.9%-28.9%]; >1 race or ethnicity, 16.7% [95% CI, 7.1%-26.3%]), treatment by a nonspecialist clinician (Latinx, 7.3% [95% CI, 3.3%-11.3%]; >1 race or ethnicity, 4.8% [95% CI, 1.9%-7.7%]), and use of any psychotropic medication prescription (Latinx, 11.6% [95% CI, 7.3%-15.9%]; >1 race or ethnicity, 8.3% [95% CI, 2.8%-13.7]). Compared with White adolescents, Black adolescents had lower rates of MDD treatment by any clinician (31.7% [95% CI, 23.7%-39.8%]) and by nonspecialist clinicians (8.4% [95% CI, 3.8%-13.2%]) and experienced lower prescription rates for any psychotropic medication (12.6 [95% CI, 4.6%-20.6%]). Asian (16.0% [95% CI, 5.0%-27.2%]) and Latinx (17.8% [95% CI, 12.6%-23.0%]) adolescents had lower rates of virtual mental health treatment compared with White adolescents. Black (19.1% [95% CI, 14.1%-24.2%]) and Latinx (17.9% [95% CI, 15.0%-21.1%]) adolescents had lower rates of appointments transition to telehealth, while Black adolescents (14.1% [95% CI, 10.7%-17.4%]) experienced delays getting their prescriptions. Conclusions and Relevance During the first full calendar year of the pandemic, approximately 1 in 5 adolescents had MDD, and less than half of adolescents who needed treatment had any mental health treatment. Adolescents in racial and ethnic minority groups, particularly Latinx, experienced the lowest treatment rates. Federal policy should target adolescents as a whole, and minority populations in particular, to ensure equitable treatment access. Efforts should consider the social, racial, ethnic, and cultural determinants of health.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Nicholas J. Carson
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L. Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Burke CT, Calear AL, Cruwys T, Batterham PJ. Are Parents the Key? How Parental Suicide Stigma and Suicide Literacy Affect Help-Seeking Attitudes and Intentions for their Child. J Youth Adolesc 2023; 52:2417-2429. [PMID: 37592195 PMCID: PMC10495472 DOI: 10.1007/s10964-023-01841-3] [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: 02/19/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
Suicide is the leading cause of death among Australian young people, yet rates of help-seeking for suicidal ideation and behaviors in this population are concerningly low. In this study, the relationships between parental suicide stigma, parental suicide literacy, and their attitudes and intentions toward seeking professional help for their child if they were to express thoughts of suicide are investigated. Understanding this influence is critical given parents are key facilitators of their child's access to and engagement with professional mental health services. An online survey was administered to 302 parents of children aged-12-18 (Mage = 45.36, SDage = 6.23; 91.4% female). Parental suicide stigma was significantly associated with more negative help-seeking attitudes and lower help-seeking intentions. Other significant predictors of more positive help-seeking attitudes included parental self-efficacy and having a child with no history of suicidal ideation. Higher help-seeking intentions were associated with female gender, living in an urban area, and positive help-seeking attitudes. Parental suicide literacy was not significantly associated with help-seeking. Practically, outcomes of this study may inform the development and implementation of targeted education programs to increase parental help-seeking for their children.
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Affiliation(s)
- Colette T Burke
- School of Medicine and Psychology, The Australian National University, Building 39 Science Road, Canberra, ACT, 2601, Australia.
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - Tegan Cruwys
- School of Medicine and Psychology, The Australian National University, Building 39 Science Road, Canberra, ACT, 2601, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
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