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Gibson RC, Lowe G, Lipps G, Jules MA, Romero-Acosta K, Daley A. Somatic and Depressive Symptoms Among Children From Latin America and the English-Speaking Caribbean. Clin Child Psychol Psychiatry 2024; 29:439-452. [PMID: 37230742 DOI: 10.1177/13591045231178890] [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] [Indexed: 05/27/2023]
Abstract
BACKGROUND The extent to which depression is associated with somatic complaints in children from the English-speaking Caribbean and Latin America is not well established. OBJECTIVE We sought to explore the association between depressive and somatic symptoms among children from the English-speaking Caribbean and Latin America, while accounting for age, sex, socioeconomic status, cultural background, and anxiety score. METHOD 1541 elementary school children, ages 9-12 years, from the English-speaking Caribbean and Latin America completed the Adolescent Depression Rating Scale (ARDS), the Numeric 0-10 Anxiety Self-Report Scale and the Children's Somatic Symptom Inventory-24 (CSSI-24). T-tests and ANOVA's were used to compare CSSI-24 and ARDS scores among countries, and the CSSI-24 scores of children with (ARDS ≥ 4) and without likely clinically significant depression. Regression analyses assessed possible predictors of CSSI-24 score. RESULTS Depressive and somatic symptom scores were highest among the Jamaican children and lowest among the Colombian children (p < .001). Children with likely clinically significant depression exhibited higher mean somatic symptom scores (p < .001). Depressive symptom scores predicted somatic symptom scores (p < .001). CONCLUSIONS Depressive symptoms were a strong predictor of reporting somatic symptoms. Knowledge of this association may facilitate better recognition of depression among youth.
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Affiliation(s)
- Roger C Gibson
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Gillian Lowe
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Garth Lipps
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Kingston, Jamaica
| | - Mia A Jules
- Department of Education, The University of the West Indies, Cave Hill, Barbados
| | - Kelly Romero-Acosta
- Department of Psychological Research, Corporación Universitaria Del Caribe CECAR, Sincelejo, Colombia
| | - Avril Daley
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
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2
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Smárason O, Guzick AG, Goodman WK, Salloum A, Storch EA. Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care. J Child Adolesc Psychopharmacol 2023; 33:316-324. [PMID: 37861988 PMCID: PMC10616955 DOI: 10.1089/cap.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction: Computer-assisted cognitive behavioral therapy (CCBT) for childhood anxiety disorders may aid the dissemination of CBT, while maintaining treatment fidelity. Although CCBT is an effective intervention, not everyone benefits equally from treatment. Identifying patient characteristics that predict who will benefit from treatment and to what extent can help with matching patients to suitable interventions, and allow researchers and clinicians to modify, and individualize, their treatment formats more effectively. Such predictors and moderators have not yet been examined for CCBT outcomes in anxious children and studies of more traditional treatment formats have yielded inconsistent results. Methods: Using data from a randomized clinical trial evaluating CCBT for children with anxiety disorders, this study examined predictors and moderators of treatment outcomes in a sample of 100 children (age: mean [M] = 9.82, standard deviation [SD] = 1.82), randomized to either CCBT (n = 49) or standard community care (n = 51). Potential predictors and moderators were identified from the literature and examined in stepwise multiple linear regression models, using posttreatment anxiety severity and global impairment as outcomes. Results: Parent-rated internalizing symptoms predicted posttreatment anxiety severity for both treatment groups. High pretreatment levels of anxiety severity predicted higher global impairment at posttreatment for the group receiving community care, but not for the CCBT group. Conclusion: Further research is needed to clarify which patient characteristics are associated with CCBT outcomes in a consistent way. ClinicalTrials.gov identifier: NCT01416805.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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3
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Riddle DB, Guzick A, Minhajuddin A, Smárason O, Armstrong GM, Slater H, Mayes TL, Goodman LC, Baughn DL, Martin SL, Wakefield SM, Blader J, Brown R, Goodman WK, Trivedi MH, Storch EA. Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations. J Obsessive Compuls Relat Disord 2023; 38:100820. [PMID: 37521713 PMCID: PMC10373162 DOI: 10.1016/j.jocrd.2023.100820] [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] [Indexed: 08/01/2023]
Abstract
Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8-20 years who met diagnostic criteria for depression alone, depression with co-occurring OCD or any anxiety disorder were included in the present study. Rates of comorbid anxiety and OCD were very high (60.5% and 15.5%, respectively). Relative to youth with only depression, depressed youth with comorbid OCD or anxiety had greater severity of depression, suicidality, and overall impairment in social, physical, and emotional functioning. These results highlight the contribution of OCD or anxiety comorbidity in more complex clinical presentations for depressed youth.
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Affiliation(s)
- David B Riddle
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Orri Smárason
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabrielle M Armstrong
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lynnel C Goodman
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denise L Baughn
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah L Martin
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- Department of Psychiatry and Behavioral Sciences, University of Texas, Austin, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Brief Behavioral Therapy for Anxiety and Depression in Pediatric Primary Care: Breadth of Intervention Impact. J Am Acad Child Adolesc Psychiatry 2023; 62:230-243. [PMID: 36030033 DOI: 10.1016/j.jaac.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/01/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report on broad-based outcomes of the Brief Behavioral Therapy (BBT) trial for pediatric anxiety and depression. Secondary data analyses expand on previous reports by assessing diagnostic remission and independent functioning, impact on targeted psychopathology, and spillover effects on non-targeted outcomes. METHOD Youth (N = 185; 8-16.9 years; 58% female; 78% White; 21% Hispanic) with anxiety and/or depression were eligible for this multi-site trial. Enrolled youth were randomly assigned to receive 8 to 12 sessions of BBT in primary care or assisted referral to outpatient care (ARC). Assessments were conducted 16 and 32 weeks post randomization. RESULTS BBT was superior to ARC on remission of all targeted diagnoses (week 16: 56.8% vs 28.2%, p < .001; week 32: 62.5% vs 38.9%, p = .004), clinician-rated independent functioning (week 16: 75.0% vs 45.7%, p < .001; week 32: 81.2% vs 55.7%, p < .001), and on measures of anxiety, depression, suicide items, total comorbid behavioral and emotional problems, and hyperactivity (d = 0.21-0.49). Moderation analyses revealed superior outcomes for Hispanic youth in BBT vs ARC for diagnostic remission, anxiety, emotional problems, and parent-child conflict. Youth depression at baseline moderated effects on peer problems and parent-child conflict, with effects favoring BBT. Significant main and moderated effects of BBT on change in non-targeted outcomes were largely mediated by change in anxiety (24.2%-49.3% of total effects mediated). CONCLUSION BBT has positive effects on youth, mediated by the strong impact of the intervention on anxiety. Analyses continue to support positive outcomes for Hispanic youth, suggesting that BBT is a broadly effective transdiagnostic treatment option for diverse populations. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://clinicaltrials.gov; NCT01147614.
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Weersing VR, Gonzalez A, Hatch B, Lynch FL. Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:80-88. [PMID: 36177440 PMCID: PMC9477232 DOI: 10.1176/appi.prcp.20210044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden from disorder as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Increasing access to services for anxiety and depression is of critical and immediate importance for racial/ethnic minority families. Issues of access may be associated with the physical location of services (e.g., primary care or telehealth) or with barriers of language, income, or financing. Both service settings and research treatment protocols frequently require families of ethnic/racial minority youths to fit themselves to the demands of care, in ways that may not be culturally compatible (e.g., little parent involvement in treatment) or practically feasible (i.e., weekly sessions during parent working hours). Whenever possible, non‐essential aspects of intervention should be freed to match patient preferences and constraints, and interventions for anxiety and depression should be adopted that have broad impacts and options for personalization of goals.
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Affiliation(s)
- V. Robin Weersing
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Araceli Gonzalez
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Brigit Hatch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Frances L. Lynch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
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Amendola S, Hengartner MP, Spensieri V, Grillo L, Cerutti R. Patterns of internalizing symptoms and disability functioning in children and adolescents. Eur Child Adolesc Psychiatry 2022; 31:1455-1464. [PMID: 33909142 DOI: 10.1007/s00787-021-01789-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 12/19/2022]
Abstract
Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8-16 years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: "High somatic symptoms and average depression/anxiety"; cluster 2: "High somatic symptoms and high depression/anxiety"; cluster 3: "Average somatic symptoms and above average depression/anxiety"; and cluster 4: "Low somatic symptoms and low depression/anxiety". Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, Zurich, 8005, Switzerland
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Luciano Grillo
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy.
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7
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Sheldrick RC, Bair-Merritt MH, Durham MP, Rosenberg J, Tamene M, Bonacci C, Daftary G, Tang MH, Sengupta N, Morris A, Feinberg E. Integrating Pediatric Universal Behavioral Health Care at Federally Qualified Health Centers. Pediatrics 2022; 149:185679. [PMID: 35347338 DOI: 10.1542/peds.2021-051822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs). METHODS FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation. RESULTS Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state's long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children <5 years, 53.8% of 5-12 years, and 74.6% >12 years were referred for care. Children seen by BH staff on the day of referral (ie, "warm hand-off") were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03). CONCLUSIONS Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.
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Affiliation(s)
| | | | - Michelle P Durham
- Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Psychiatry, Boston Medical Center, Boston, Massachusetts
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Fujisato H, Kato N, Namatame H, Ito M, Usami M, Nomura T, Ninomiya S, Horikoshi M. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Japanese Children: A Pilot Study. Front Psychol 2021; 12:731819. [PMID: 34899471 PMCID: PMC8654783 DOI: 10.3389/fpsyg.2021.731819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
At present, there is no established cognitive behavioral therapy (CBT) for treating emotional disorders in Japanese children. Therefore, we introduced the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Japan and adapted it to the Japanese context. We then examined its feasibility and preliminary efficacy using a single-arm pretest, posttest, follow-up design. Seventeen Japanese children aged between 8 and 12 years (female n = 11; male n = 6; M = 10.06 ± 0.97 years) with a principal diagnosis of anxiety, obsessive-compulsive, or depressive disorders, and their parents were enrolled in the study. The primary outcome was the overall severity of emotional disorders as assessed by psychiatrists using the Clinical Global Impression-Severity Scale. Secondary outcomes included child- and parent-reported anxiety symptoms, depressive symptoms, and functional status. No severe adverse events were observed. The feasibility was confirmed by the low dropout proportion (11.76%), high attendance proportion (children: 95.6%; parents: 94.6%), and sufficient participant satisfaction. Linear mixed models (LMMs) showed that the overall severity of emotional disorders and child- and parent-reported anxiety symptoms improved from pre-treatment to post-treatment, and that these treatment effects were maintained during the 3-month follow-up period. Additionally, child- and parent-reported functional status improved from pre-treatment to the 3-month follow-up. In contrast, child-reported depressive symptoms improved from pre-treatment to follow-up, but there was no significant change in parent-reported depressive symptoms between pre-treatment and other time points. These findings demonstrate the feasibility and preliminary efficacy of the Japanese version of the UP-C, suggesting that future randomized controlled trials (RCTs) are warranted (Clinical trial registration: UMIN000026911).
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Affiliation(s)
- Hiroko Fujisato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikari Namatame
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Faculty of Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masahide Usami
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Tomoko Nomura
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan.,Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Shuzo Ninomiya
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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9
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Bloom PA, Douglas I, VanTieghem M, Tottenham N, Callaghan B. Using gastrointestinal distress reports to predict youth anxiety risk: Implications for mental health literacy and community care. Dev Psychobiol 2021; 63:e22126. [PMID: 33948944 DOI: 10.1002/dev.22126] [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: 10/09/2020] [Revised: 03/29/2021] [Accepted: 04/10/2021] [Indexed: 11/09/2022]
Abstract
This study investigates the generalizability and predictive validity of associations between gastrointestinal (GI) symptoms and youth anxiety to establish their utility in community mental health decision-making. We analyzed data from youth ages 3 to 21 years in volunteer cohorts collected in Los Angeles (N = 327) and New York City (N = 102), as well as the Healthy Brain Network cohort (N = 1957). Youth GI distress was measured through items taken from the parent-reported Child Behavior Checklist (CBCL). We examined generalizability of GI-anxiety associations across cohorts and anxiety reporters, then evaluated the performance of these models in predicting youth anxiety in holdout data. Consistent with previous work, higher levels of gastrointestinal distress were associated with more parent-reported youth anxiety behaviors in all three cohorts. Models trained on data from the Healthy Brain Network cohort predicted parent-reported and child-reported anxiety behaviors, as well as clinician-evaluated anxiety diagnoses, at above chance levels in holdout data. Models which included GI symptoms often, but not always, outperformed models based on age and sex alone in predicting youth anxiety. Based on the generalizability and predictive validity of GI-anxiety associations investigated here, GI symptoms may be an effective tool for child-facing professionals for identifying children at risk for anxiety (Preprint: https://psyarxiv.com/zgavu/).
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Affiliation(s)
| | - Ian Douglas
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | | | - Nim Tottenham
- Psychology Department, Columbia University, New York, New York, USA
| | - Bridget Callaghan
- Psychology Department, University of California Los Angeles, Los Angeles, California, USA
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10
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Khanano R, Barbic S, Henderson J, Mathias S, Richardson CG. Reliability and Concurrent Validity of the GAIN Short Screener Among Youth Utilizing Integrated Health Services. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:82-91. [PMID: 33953760 PMCID: PMC8056962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES There is increasing interest in the identification of mental disorders among youth through routine screening in integrated health services. One tool currently being used in Canada is the Global Appraisal of Individual Needs Short Screener (GAIN-SS). The aims of this study were to (1) estimate the internal consistency of the GAIN-SS and its internalizing disorder screener (IDScr) (2) examine concurrent validity of the GAIN-SS and IDScr in an integrated youth health service centre, and (3) identify clinical cut-points for youth aged 17-24 years. METHOD Participants [n=201, gender=44% women, median age 21 (min,max: 17,24) years] were recruited from an integrated youth health service in Vancouver, British Columbia. Participants completed the GAIN-SS and three reference measures: Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7). Cronbach's alpha, sensitivity, and specificity of the GAIN-SS and IDScr were examined using the K-10, PHQ-9 and GAD-7 as reference measures. Receiver operator characteristic curves were generated to identify optimal cut-points for the GAIN-SS and IDScr. RESULTS A cut-point of seven for the GAIN-SS optimized sensitivity (90%) and specificity (42%) with Cronbach's alpha of 0.91. A similar pattern of results was found for the IDScr and the reference measures it was tested against. CONCLUSION The results indicate that the GAIN-SS and IDScr have acceptable sensitivity but poor specificity that could be improved via the optimal cut-points identified in this study. This low specificity may be acceptable within an integrated youth health service that provides follow-up diagnostic assessments by a clinician.
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Affiliation(s)
- Raymond Khanano
- UBC School of Population and Public Health (SPPH), University of British Columbia, Vancouver, British Columbia
| | - Skye Barbic
- UBC Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia
- Foundry, University of British Columbia, Vancouver, British Columbia
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, British Columbia
- Providence Health Care Research Institute (PHCRI), St. Paul's Hospital, Vancouver, British Columbia
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Steve Mathias
- Foundry, University of British Columbia, Vancouver, British Columbia
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, British Columbia
- Providence Health Care Research Institute (PHCRI), St. Paul's Hospital, Vancouver, British Columbia
- UBC Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Christopher G Richardson
- UBC School of Population and Public Health (SPPH), University of British Columbia, Vancouver, British Columbia
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, British Columbia
- Providence Health Care Research Institute (PHCRI), St. Paul's Hospital, Vancouver, British Columbia
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11
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Trafalis S, Giannini C, Joves J, Portera S, Toyama H, Mehta A, Basile K, Friedberg RD. A pediatrician-friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations. Pediatr Investig 2021; 5:58-64. [PMID: 33778429 PMCID: PMC7984009 DOI: 10.1002/ped4.12246] [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: 09/21/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
Behavioral health concerns are surging in pediatric practices. Fortunately, integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load. Routine screening of behavioral health problems in primary care facilities enables early identification and treatment. However, deciding on sound, efficient, and scalable screening measures is sometimes arduous. Accordingly, this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety, depression, and conduct problems. Psychometric findings and clinical applications of the Pediatric Symptom Checklist-17 (PSC-17), the Patient Health Questionnaire-9 (PHQ-9), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) are delineated. Finally, clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.
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Affiliation(s)
- Sandra Trafalis
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Courtney Giannini
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Jeremy Joves
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Saige Portera
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Hannah Toyama
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Anika Mehta
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Krista Basile
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Robert D. Friedberg
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
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12
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Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting. J Clin Psychol Med Settings 2021; 28:757-770. [PMID: 33564959 DOI: 10.1007/s10880-021-09763-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 12/18/2022]
Abstract
This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.
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13
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Danneel S, Geukens F, Maes M, Bastin M, Bijttebier P, Colpin H, Verschueren K, Goossens L. Loneliness, Social Anxiety Symptoms, and Depressive Symptoms in Adolescence: Longitudinal Distinctiveness and Correlated Change. J Youth Adolesc 2020; 49:2246-2264. [PMID: 32918664 DOI: 10.1007/s10964-020-01315-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
Loneliness, social anxiety symptoms, and depressive symptoms are internalizing problems that are highly intertwined and often co-occur during adolescence. This overlap and co-occurrence raises the question whether three different labels are used for the same underlying phenomenon. The present study adopts a comprehensive approach to this issue by investigating the development of the three phenomena simultaneously. Specifically, this study aimed to investigate (1) the developmental trend for all three internalizing problems separately, (2) whether they are best described by a single developmental trend, (3) how they co-develop across adolescence, and (4) gender differences in this co-development. The analyses were run in three three-wave longitudinal samples of adolescents with one-year intervals in order to verify the robustness of the findings. Sample 1 (roughly ages 15, 16, and 17) comprised 549 adolescents (63% girls), and Samples 2 and 3 (roughly ages 13, 14, and 15) comprised 811 adolescents (46% girls) and 1101 adolescents (52% girls), respectively. Latent growth curve modeling for the three phenomena separately showed either small increases or stable patterns. A comparison of a Multiple Indicator Latent Growth Model (MILGM) with a Parallel Process Latent Growth Curve Modeling (PPLGCM) showed that the three internalizing problems followed unique, but related, developmental trends across adolescence. The intercepts of the three phenomena were positively correlated with one another in all samples and increases in loneliness were associated consistently with increases in social anxiety symptoms. Only in Sample 3 evidence was found for a similar association between loneliness and depressive symptoms and between social anxiety symptoms and depressive symptoms. Except for differences in initial levels, gender differences in the development of the three problems were limited. Overall, the results of the present study clearly indicate that the three internalizing problems are longitudinally distinct from one another, but co-develop across adolescence.
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Affiliation(s)
- Sofie Danneel
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Flore Geukens
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium.
| | - Marlies Maes
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Margot Bastin
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Patricia Bijttebier
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Hilde Colpin
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Karine Verschueren
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
| | - Luc Goossens
- School Psychology and Development in Context, KU Leuven, Tiensestraat 102, Box 3717, 3000, Leuven, Belgium
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14
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Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. J Am Acad Child Adolesc Psychiatry 2020; 59:856-867. [PMID: 31278996 PMCID: PMC6940557 DOI: 10.1016/j.jaac.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. METHOD A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. RESULTS At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). CONCLUSION BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.
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15
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Herskovic V, Matamala M. Somatización, ansiedad y depresión en niños y adolescentes. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Silk JS, Pramana G, Sequeira SL, Lindhiem O, Kendall PC, Rosen D, Parmanto B. Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders. Behav Ther 2020; 51:69-84. [PMID: 32005341 PMCID: PMC6995786 DOI: 10.1016/j.beth.2019.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.
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Affiliation(s)
- Jennifer S. Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Gede Pramana
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | | | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Dana Rosen
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
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17
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A Four-Year Prospective Study of Bullying, Anxiety, and Disordered Eating Behavior Across Early Adolescence. Child Psychiatry Hum Dev 2019; 50:815-825. [PMID: 30915621 DOI: 10.1007/s10578-019-00884-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We investigated the developmental pathways by which bullying perpetration and victimization, anxiety, and disordered eating behavior were related. Participants were drawn from the Canadian McMaster Teen Study. From Grade 5-8 (age 10-14), students (n = 657) were assessed on bullying involvement and symptoms of anxiety, and in Grade 7 and 8, students additionally completed a measure of clinically significant disordered eating behavior. Bullying victimization initiated a cascading effect on bullying perpetration, which subsequently led to disordered eating behavior. Anxiety had direct effects on disordered eating behavior at multiple time points and initiated a cascading effect on bullying victimization, and subsequently, perpetration. There was no evidence of moderation by sex. Bullying perpetration and anxiety may serve as early signals of eating pathology. Bullying prevention programs may attenuate the risk of disordered eating in both sexes, and the high continuity of disordered eating behavior suggests that early intervention is critical.
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18
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Kim JHJ, Tsai W, Kodish T, Trung LT, Lau AS, Weiss B. Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence. J Psychosom Res 2019; 124:109763. [PMID: 31443807 PMCID: PMC6709866 DOI: 10.1016/j.jpsychores.2019.109763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/20/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples. METHODS 304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis. RESULTS Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents. CONCLUSIONS Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, United States of America.
| | - William Tsai
- Department of Applied Psychology, New York University, United States of America
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Lam T Trung
- Danang Psychiatric Hospital, Danang, Vietnam
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, United States of America
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19
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Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial. BMC Psychiatry 2019; 19:200. [PMID: 31248384 PMCID: PMC6598366 DOI: 10.1186/s12888-019-2168-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR. METHODS We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated. DISCUSSION The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs. TRIAL REGISTRATION The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.
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20
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Rozenman M, Piacentini J, O'Neill J, Bergman RL, Chang S, Peris TS. Improvement in anxiety and depression symptoms following cognitive behavior therapy for pediatric obsessive compulsive disorder. Psychiatry Res 2019; 276:115-123. [PMID: 31075706 PMCID: PMC7197731 DOI: 10.1016/j.psychres.2019.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/12/2023]
Abstract
Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.
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Affiliation(s)
- Michelle Rozenman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.
| | - John Piacentini
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
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21
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Thorlacius Ö, Gudmundsson E. The Effectiveness of the Children’s Emotional Adjustment Scale (CEAS) in Screening for Mental Health Problems in Middle Childhood. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9296-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Campo JV, Geist R, Kolko DJ. Integration of Pediatric Behavioral Health Services in Primary Care: Improving Access and Outcomes with Collaborative Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:432-438. [PMID: 29673268 PMCID: PMC6099777 DOI: 10.1177/0706743717751668] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine collaborative care interventions to integrate pediatric mental health services into primary care as a means of addressing barriers to mental health service delivery, improving access to care, and improving health outcomes. METHOD Selective review of published literature addressing structural and attitudinal barriers to behavioural health service delivery and the integration of behavioural health services for pediatric mental problems and disorders into primary care settings, with a special focus on Canadian and U.S. RESULTS Integration of pediatric behavioural health services in primary care has potential to address structural and attitudinal barriers to care delivery, including shortages and the geographical misdistribution of behavioural health specialists. Integration challenges stigma by communicating that health cannot be compartmentalized into physical and mental components. Stepped collaborative care interventions have been demonstrated to be feasible and effective in improving access to behavioural health services, outcomes, and patient and family satisfaction relative to existing care models. CONCLUSION Collaborative integration of behavioural health services into primary care is a promising means of improving access to care and outcomes for children and adolescents struggling with mental problems and disorders. Dissemination to real-world practice settings will likely require changes to existing models of reimbursement and the culture of health service delivery.
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Affiliation(s)
- John V Campo
- 1 Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Rose Geist
- 2 Medical Psychiatry Alliance, Mental Health Program, Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada
| | - David J Kolko
- 3 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Sterrett-Hong EM, Karam E, Kiaer L. Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:792-809. [PMID: 28120298 DOI: 10.1007/s10488-016-0788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.
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Affiliation(s)
- Emma M Sterrett-Hong
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA.
| | - Eli Karam
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA
| | - Lynn Kiaer
- Hornby Zeller Associates, Inc., Troy, USA
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Wols A, Lichtwarck-Aschoff A, Schoneveld EA, Granic I. In-Game Play Behaviours during an Applied Video Game for Anxiety Prevention Predict Successful Intervention Outcomes. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018; 40:655-668. [PMID: 30459485 PMCID: PMC6223766 DOI: 10.1007/s10862-018-9684-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety disorder is the most prevalent and frequently diagnosed disorder in youth, and associated with serious negative health outcomes. Our most effective prevention programs, however, have several limitations. These limitations can be addressed using game-based interventions. Results from two randomized controlled trials on the video game MindLight show improvements in anxiety that are maintained up to 6 months. The game was designed based on evidence-based therapeutic techniques; however, it is unclear if children's engagement with these techniques actually predict improvements in anxiety symptoms. An important advantage of game-based interventions is that they provide excellent opportunities to isolate therapeutic action mechanisms and test their impact on intervention outcomes. In the current study, on-screen videotaped output while playing MindLight was coded and analysed for forty-three 8 to 12-year old children with elevated levels of anxiety. Results showed that changes in in-game play behaviours representing therapeutic exposure techniques predicted improvements in anxiety symptoms 3 months later (when children had not played the game for 3 months). The current study is a first step towards identifying and validating game mechanics that can be used in new applied games to target anxiety symptoms or other psychopathologies with the same underlying deficits.
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Affiliation(s)
- Aniek Wols
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Anna Lichtwarck-Aschoff
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Elke A. Schoneveld
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
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Marchette LK, Weisz JR. Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry 2017; 58:970-984. [PMID: 28548291 DOI: 10.1111/jcpp.12747] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychotherapy for children and adolescents (herein, 'youths') has grown more precise and focused over the decades, shifting toward empirically supported treatments standardized via therapist manuals. The manuals have increasingly emphasized precise targeting of single disorders or problems, or homogenous clusters. These focal treatments represent a valuable advance, with intervention benefit documented in hundreds of studies. However, relatively few of these treatments are widely used in everyday clinical practice, and their level of benefit may not be ideal, particularly in practice contexts and when compared to usual clinical care. THESIS These limitations may be due, in part, to a mismatch between focal treatment design and the young people treated in real-world clinical care, who are diagnostically heterogeneous, and very frequently present with comorbidity. Improved fit may be achieved via transdiagnostic treatment approaches designed to address multiple disorders and problems, if these approaches can retain the benefits of manualization and the substantive clinical strength that has generated empirical support to date. SCOPE Here we review the evolution of empirically-based youth psychotherapy from focal treatment manuals toward transdiagnostic approaches, and we describe and illustrate three transdiagnostic treatment strategies: (a) a core dysfunction approach, (b) a common elements and modular design approach, and (c) a principle-guided approach. CLINICAL APPLICATIONS We complement research findings with a clinical perspective based on our use of manual-guided transdiagnostic intervention in clinical care settings, and we propose directions for research and practice.
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Affiliation(s)
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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26
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Dudeney J, Sharpe L, Jaffe A, Jones EB, Hunt C. Anxiety in youth with asthma: A meta-analysis. Pediatr Pulmonol 2017; 52:1121-1129. [PMID: 28749088 DOI: 10.1002/ppul.23689] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/19/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Anxiety often presents comorbidly with asthma in youth under 18; however, prevalence rates are unclear. The aim of this review was to provide an up-to-date analysis of the literature investigating the prevalence of anxiety disorders, and comparisons of anxiety disorders and symptomatology in youth with asthma, compared to those without. METHODS A systematic search was conducted using the databases PsycINFO, MEDLINE, EMBASE, and CINAHL. RESULTS The search process produced 15 studies (n = 7443) reporting data on youth with asthma and anxiety disorders, 11 studies (n = 10 332) reporting data on youth with and without asthma and anxiety disorders, and 28 studies (n = 5848) reporting data on youth with and without asthma and anxiety symptomatology. Youth with asthma had an anxiety disorder prevalence rate of 22.7%. Youth with asthma also had a greater number of anxiety disorders, compared to those without asthma (d = 0.37, 95%CI: 0.24-0.50, P < 0.001), and higher levels of anxiety symptomatology than youth without asthma (d = 0.29, 95%CI: 0.19-0.39, P < 0.001). CONCLUSIONS Youth with asthma display a prevalence rate for anxiety disorders that is more than three times higher than the prevalence in healthy youth. For the specific anxiety disorders investigated, elevated prevalence rates for youth with asthma were also found. Future research needs to focus on the factors that mediate or predict the development and maintenance of anxiety in youth with asthma and the development of clinically efficacious treatments.
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Affiliation(s)
- Joanne Dudeney
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Emma B Jones
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Lee YS, Krishnan A, Park YS. Psychometric Properties of the Children’s Depression Inventory. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1177/0748175611428329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Young-Sun Lee
- Teachers College, Columbia University, New York, NY, USA
| | | | - Yoon Soo Park
- Teachers College, Columbia University, New York, NY, USA
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28
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Rozenman M, Peris T, Bergman RL, Chang S, O'Neill J, McCracken JT, Piacentini J. Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD. Child Psychiatry Hum Dev 2017; 48:63-72. [PMID: 27225633 PMCID: PMC5860879 DOI: 10.1007/s10578-016-0653-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.
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Affiliation(s)
- Michelle Rozenman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA.
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - R Lindsey Bergman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Joseph O'Neill
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - James T McCracken
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
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29
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Yap MBH, Morgan AJ, Cairns K, Jorm AF, Hetrick SE, Merry S. Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clin Psychol Rev 2016; 50:138-158. [PMID: 27969003 DOI: 10.1016/j.cpr.2016.10.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE OF THE RESEARCH Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
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Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn Cairns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Merry
- School of Medicine, University of Auckland, New Zealand
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30
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Ask H, Waaktaar T, Seglem KB, Torgersen S. Common Etiological Sources of Anxiety, Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:101-14. [PMID: 25619928 DOI: 10.1007/s10802-015-9977-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Somatic complaints in children and adolescents may be considered part of a broader spectrum of internalizing disorders that include anxiety and depression. Previous research on the topic has focused mainly on the relationship between anxiety and depression without investigating how common somatic symptoms relate to an underlying factor and its etiology. Based on the classical twin design with monozygotic and dizygotic twins reared together, our study aimed to explore the extent to which the covariation between three phenotypes in adolescent girls and boys can be represented by a latent internalizing factor, with a focus on both common and specific etiological sources. A population-based sample of twins aged 12-18 years and their mothers and fathers (N = 1394 families) responded to questionnaire items measuring the three phenotypes. Informants' ratings were collapsed using full information maximum likelihood estimated factor scores. Multivariate genetic analyses were conducted to examine the etiological structure of concurrent symptoms. The best fitting model was an ACE common pathway model without sex limitation and with one substantially heritable (44%) latent factor shared by the phenotypes. Concurrent symptoms also resulted from shared (25%) and non-shared (31%) environments. The factor loaded most on depression symptoms and least on somatic complaints. Trait-specific influences explained 44% of depression variance, 59% of anxiety variance, and 65% of somatic variance. Our results suggest the presence of a general internalizing factor along which somatic complaints and mental distress can be modeled. However, specific influences make the symptom types distinguishable.
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Affiliation(s)
- Helga Ask
- Centre for Child and Adolescent Mental Health, RBUP Eastern and Southern Norway, Nydalen, P.O box 4623, 0405, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Blindern, P.O box 1094, 0317, Oslo, Norway.
| | - Trine Waaktaar
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Blindern, P.O box 1094, 0317, Oslo, Norway
| | - Karoline Brobakke Seglem
- Centre for Child and Adolescent Mental Health, RBUP Eastern and Southern Norway, Nydalen, P.O box 4623, 0405, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Blindern, P.O box 1094, 0317, Oslo, Norway
| | - Svenn Torgersen
- Centre for Child and Adolescent Mental Health, RBUP Eastern and Southern Norway, Nydalen, P.O box 4623, 0405, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Blindern, P.O box 1094, 0317, Oslo, Norway
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31
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Rozenman M, Piacentini J. Pediatric primary care as a stepped care setting for youth anxiety: Commentary on “What steps to take? How to approach concerning anxiety in youth”. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Weisz J, Bearman SK, Santucci LC, Jensen-Doss A. Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:44-58. [DOI: 10.1080/15374416.2016.1163708] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- John Weisz
- Department of Psychology, Harvard University
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33
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Hersh J, Metz KL, Weisz JR. New Frontiers in Transdiagnostic Treatment: Youth Psychotherapy for Internalizing and Externalizing Problems and Disorders. Int J Cogn Ther 2016. [DOI: 10.1521/ijct.2016.9.2.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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34
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Family process and youth internalizing problems: A triadic model of etiology and intervention. Dev Psychopathol 2016; 29:273-301. [DOI: 10.1017/s095457941600016x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractDespite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic modelof family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the model's implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.
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35
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Waszczuk MA, Zavos HMS, Gregory AM, Eley TC. The stability and change of etiological influences on depression, anxiety symptoms and their co-occurrence across adolescence and young adulthood. Psychol Med 2016; 46:161-75. [PMID: 26310536 PMCID: PMC4673666 DOI: 10.1017/s0033291715001634] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood. METHOD A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years. RESULTS Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms. CONCLUSIONS The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches.
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Affiliation(s)
- M. A. Waszczuk
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - H. M. S. Zavos
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - A. M. Gregory
- Department of Psychology,
Goldsmiths, University of London,
London, UK
| | - T. C. Eley
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
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36
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Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: Initial randomized controlled trial. Behav Res Ther 2015; 76:65-75. [PMID: 26655958 DOI: 10.1016/j.brat.2015.11.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
Anxiety and depression are debilitating and commonly co-occurring in young adolescents, yet few interventions are designed to treat both disorder classes together. Initial efficacy is presented of a school-based transdiagnostic group behavioral activation therapy (GBAT) that emphasizes anti-avoidance in vivo exposure. Youth (N = 35; ages 12-14; 50.9% male) were randomly assigned to either GBAT (n = 21) or WL (n = 14) after completing a double-gated screening process. Multi-reporter, multi-domain outcomes were assessed at pretreatment, posttreatment, and four-month follow-up (FU). GBAT was associated with greater posttreatment remission rates than WL in principal diagnosis (57.1% vs. 28.6%; X1(2) = 2.76, p = .09) and secondary diagnosis (70.6% vs. 10%; X1(2) = 9.26, p = .003), and greater improvement in Clinical Global Impairment - Severity ratings, B = -1.10 (0.42), p = .01. Symptom outcomes were not significantly different at posttreatment. GBAT produced greater posttreatment behavioral activation (large effect size) and fewer negative thoughts (medium effect), two transdiagnostic processes, both at the trend level. Most outcomes showed linear improvement from pretreatment to FU that did not differ depending on initial condition assignment. Sample size was small, but GBAT is a promising transdiagnostic intervention for youth anxiety and unipolar mood disorders that can feasibly and acceptably be applied in school settings.
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Affiliation(s)
- Brian C Chu
- Department of Clinical Psychology, Rutgers University, USA.
| | - Sofia T Crocco
- Department of Clinical Psychology, Rutgers University, USA
| | - Petra Esseling
- Department of Clinical Psychology, Rutgers University, USA
| | | | | | - Laura C Skriner
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylavnia, USA
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37
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Bearman SK, Weisz JR. Review: Comprehensive treatments for youth comorbidity - evidence-guided approaches to a complicated problem. Child Adolesc Ment Health 2015; 20:131-141. [PMID: 26392814 PMCID: PMC4574497 DOI: 10.1111/camh.12092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence-based treatments (EBTs) with a single-disorder focus have improved the potential for youth mental health care, yet may be an imperfect fit to clinical care settings where diagnostic comorbidity and co-occurring problems are commonplace. Most EBTs were developed to treat one diagnosis or problem (or a small homogenous cluster), but most clinically referred youths present with multiple disorders and problems. FINDINGS Three emerging approaches may help address the comorbidity that is so common in treated youths. Conceptually unified treatments target presumed causal and maintaining factors that are shared among more than one disorder or problem area; preliminary open trials and case studies show promising results. Modular protocols combine the 'practice elements' that commonly appear in separate single-disorder EBTs and repackage them into coordinated delivery systems; one modular protocol, MATCH, has produced positive findings in a randomized effectiveness trial. Monitoring and Feedback Systems (MFSs) provide real-time data on client progress to inform clinical decision-making, encompassing comorbid and co-occurring problems; one study shows beneficial effects in everyday practice with diverse youth problems. CONCLUSIONS All three approaches - conceptually unified, modular, and MFS - can be strengthened by increased research attention to treatment integrity, clinician user-appeal, design simplicity, and the infrastructure necessary for successful implementation.
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Affiliation(s)
- Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Boston, MA, USA
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38
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Shanahan L, Zucker N, Copeland WE, Bondy CL, Egger HL, Costello EJ. Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample. Psychol Med 2015; 45:1721-1730. [PMID: 25518872 PMCID: PMC4691537 DOI: 10.1017/s0033291714002840] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity. METHOD The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. RESULTS Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders. CONCLUSIONS Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.
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Affiliation(s)
- L Shanahan
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - N Zucker
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - W E Copeland
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - C L Bondy
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - H L Egger
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - E J Costello
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
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Sullivan PJ, Keller M, Paternostro J, Friedberg RD. Treating Emotionally Dysregulated and Perfectionistic Youth with Transdiagnostic Cognitive Behavioral Procedures. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2015. [DOI: 10.1007/s10879-014-9293-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Nehmy TJ, Wade TD. Reduction in the prospective incidence of adolescent psychopathology: A review of school-based prevention approaches. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mhp.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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41
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Weiss JA. Transdiagnostic Case Conceptualization of Emotional Problems in Youth with ASD: An Emotion Regulation Approach. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2014; 21:331-350. [PMID: 25673923 PMCID: PMC4310071 DOI: 10.1111/cpsp.12084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
Abstract
Youth with autism spectrum disorder often struggle to cope with co-occurring anxiety, depression, or anger, and having both internalizing and externalizing symptoms is a common clinical presentation. A number of authors have designed cognitive-behavioral interventions to address transdiagnostic factors related to multiple emotional problems, although none have applied this focus to youth with ASD. The current review article describes how a transdiagnostic emotion regulation framework may inform cognitive-behavioral interventions for youth with ASD, which until now have focused almost exclusively on anxiety. Research is needed to empirically test how a transdiagnostic intervention can address the processes of emotion regulation and assist youth with ASD to cope with their emotional disorders.
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42
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Kolko DJ, Perrin E. The integration of behavioral health interventions in children's health care: services, science, and suggestions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014. [PMID: 24588366 DOI: 10.1080/15374416.2013.862804.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
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Affiliation(s)
- David J Kolko
- a Department of Psychiatry , University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
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43
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Kolko DJ, Perrin E. The integration of behavioral health interventions in children's health care: services, science, and suggestions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 43:216-28. [PMID: 24588366 DOI: 10.1080/15374416.2013.862804] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
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Affiliation(s)
- David J Kolko
- a Department of Psychiatry , University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
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Sofronoff K, Beaumont R, Weiss JA. Treating Transdiagnostic Processes in ASD: Going Beyond Anxiety. HANDBOOK OF AUTISM AND ANXIETY 2014. [DOI: 10.1007/978-3-319-06796-4_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Comer JS, Barlow DH. The occasional case against broad dissemination and implementation: retaining a role for specialty care in the delivery of psychological treatments. AMERICAN PSYCHOLOGIST 2014; 69:1-18. [PMID: 23915401 PMCID: PMC4260460 DOI: 10.1037/a0033582] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.
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Chu BC, Merson RA, Zandberg LJ, Areizaga M. Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2010.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chu BC. Translating Transdiagnostic Approaches to Children and Adolescents. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rohde P. Applying Transdiagnostic Approaches to Treatments With Children and Adolescents: Innovative Models That Are Ready for More Systematic Evaluation. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Recently, there has been a resurgence of research on emotion, including the socialization of emotion. In this article, a heuristic model of factors contributing to the socialization of emotion is presented. Then literature relevant to the socialization of children's emotion and emotion-related behavior by parents is reviewed, including (a) parental reactions to children's emotions, (b) socializers' discussion of emotion, and (c) socializers' expression of emotion. The relevant literature is not conclusive and most of the research is correlational. However, the existing body of data provides initial support for the view that parental socialization practices have effects on children's emotional and social competence and that the socialization process is bidirectional. In particular, parental negative emotionality and negative reactions to children's expression of emotion are associated with children's negative emotionality and low social competence. In addition, possible moderators of effects such as level of emotional arousal are discussed.
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