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Goselink RJ, Eklund A, Olsson I, Hallböök T, Malmgren K, Reilly C. Transitioning from paediatric to adult care in epilepsy: A qualitative study of adolescent experiences. Seizure 2024; 119:92-97. [PMID: 38820675 DOI: 10.1016/j.seizure.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Transition into adulthood and adult medical care is an important step in the life of young people with epilepsy. We aimed to gain a better insight into the lived experience of the transition to adulthood and adult medical care in epilepsy in Sweden, to improve future transitional care. METHODS A cross-sectional observational study with digital focus-group meetings and interviews with young people with epilepsy (16-22 years, n = 37) prior to, or after the transfer to adult care, or their primary caregivers if they had intellectual disability. We used reflexive thematic analysis to analyse the experiences and expectations on the transition to adulthood and adult medical care. RESULTS The results of the thematic analysis included four key areas during transition to adulthood and adult care for young persons with epilepsy: (I) worries on coming changes and future, (II) transfers are not smooth and adult care is less integrated, (III) epilepsy is part of a bigger picture, and (IV) parental roles change. In those with intellectual disability, parents experienced a stressful process and had to increase their efforts to coordinate all care contacts in adult care. Here, epilepsy was often experienced as a minor part of a more complex disease picture, where neurodevelopmental issues were often the primary concern. SIGNIFICANCE Transition in epilepsy is often complex due to the large burden of co-occurring disease, specifically intellectual disability and neuropsychiatric diagnoses. Transfer to adult care is experienced as unplanned and participants experience uncertainty, indicating a need for an improved transition process. As effective interventions are known in other chronic diseases, future studies should focus on the evaluation of how these approaches can be feasible and effective in young people with epilepsy.
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Affiliation(s)
- Rianne Jm Goselink
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Anna Eklund
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Colin Reilly
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
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Neufeld KM, Moaf P, Quilter M, Danguecan AN, Couture J, Dominguez D, Hendrikx O, Ng L, Schachter R, Korczak DD, Levy DM, Hiraki L, Knight AM. Evaluation of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus: Frequency, course, and associated risk factors. Lupus 2024; 33:874-885. [PMID: 38774953 PMCID: PMC11141111 DOI: 10.1177/09612033241254170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Depressive and anxiety symptoms are common in childhood-onset systemic lupus erythematosus (cSLE), yet their etiology and course remain unclear. We investigated the frequency of depressive and anxiety symptoms longitudinally in youth with cSLE, and associated socio-demographic and disease factors. METHODS Participants 8-18 years with cSLE completed baseline measures [demographic questionnaire, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Screen for Childhood Anxiety Related Disorders (SCARED), and psychiatric interview] and follow-up measures (CES-DC and SCARED) > 6 months later. Prevalence of clinically significant depressive (score >15 on CES-DC) or anxiety symptoms (score ≥25 on SCARED) was calculated at baseline and follow-up. Baseline psychiatric interview diagnoses were tabulated. Relationships between socio-demographics (neighborhood-level material deprivation, ethnic concentration, adverse childhood event history, psychiatric condition in a first-degree relative), disease-related factors (disease duration, major organ disease, disease activity, glucocorticoid use, comorbid medical condition) and baseline depressive and anxiety scores, were examined in linear regression models. Factors with univariate associations with p < 0.2 were included in multivariable adjusted models. RESULTS At baseline, of 51 participants with a mean disease duration of 4.3 years (SD 2.7), 35% (n = 18) and 35% (n = 18) had clinically significant depressive and anxiety symptoms, respectively. Anxiety disorder was diagnosed by psychiatric interview in 14% (n = 7), depressive disorders in 6% (n = 3), and post-traumatic stress disorder in 4% (n = 2). Adverse childhood events and first-degree relative with psychiatric condition were present in 40% (n = 20) and 37% (n = 18), respectively. In multivariable regression analysis, baseline depressive symptoms were positively correlated with neighbourhood-level material deprivation (β = 4.2, 95% CI [1.0, 7.3], p = 0.01) and psychiatric condition in a first-degree relative (β = 7.3, 95% CI [2.2, 12.4], p = 0.006). No associations were found between baseline anxiety scores and patient factors. At a median follow-up of 13.5 months (IQR 10.5, 18) for CES-DC (n = 34) and SCARED (n = 44), depressive and anxiety symptoms were persistent (18%, n = 6; 16%, n = 7), and newly present (24%, n = 8; 16% n = 7) at follow-up. CONCLUSION In this sample, depressive and anxiety symptoms were prevalent and persistent. Depressive symptoms correlated with neighborhood-level material deprivation, and family psychiatric history. These findings support routine psychosocial assessment in cSLE, and provision of appropriate resources.
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Affiliation(s)
- Kate M. Neufeld
- Division of Pediatric Rheumatology, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paris Moaf
- Department of Neurosciences and Mental Health, Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Quilter
- Department of Psychiatry, Whyteman’s Brae Hospital, NHS Fife, Kirkaldy, Scotland
| | - Ashley N. Danguecan
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julie Couture
- Division of Pediatric Rheumatology, Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec, Laval University, Quebec City, QC, Canada
| | - Daniela Dominguez
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Olivia Hendrikx
- Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
- Bachelor of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Lawrence Ng
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Reva Schachter
- Division of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daphne D. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Deborah M. Levy
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Linda Hiraki
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea M. Knight
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Chen M, Ren L, Jiang H, Wang Y, Zhang L, Dong C. Discrepancies in perceived family resilience between adolescents with chronic illness and parents: using response surface analysis to examine the relationship with adolescents' psychological adjustment. BMC Psychiatry 2024; 24:475. [PMID: 38937737 PMCID: PMC11210177 DOI: 10.1186/s12888-024-05917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND This study aimed to explore discrepancies in adolescents with chronic illness and their parents' perceptions of family resilience, as well as the relationship between these differences and the psychological adjustment of adolescents with chronic illness. METHODS A cross-sectional study was conducted. A total of 264 dyads of parents (77.7% mothers, mean age 41.60 years, SD = 6.17) and adolescents (48.5% girls, mean age 12.68 years, SD = 2.11) with chronic illness were recruited through convenience sampling from three children's hospitals in Wenzhou, Hangzhou, and Shanghai, China between June 2022 and May 2023. The Chinese version of the Family Resilience Scale and the Psychological Adjustment Scale, which are commonly used measures with good reliability and validity, were employed to assess family resilience and psychological adaption, respectively. The data were analyzed using polynomial regression and response surface analysis. RESULTS Adolescents with chronic illness reported higher family resilience than their parents (t=-2.80, p < 0.05). The correlations between family resilience and adolescents' psychological adjustment reported by the adolescents (r = 0.45-0.48) were higher than parents (r = 0.18-0.23). In the line of congruence, there were positive linear (a1 = 1.09-1.60, p < 0.001) and curvilinear (a2=-1.38∼-0.72, p < 0.05) associations between convergent family resilience and adolescents' psychological adjustment. In the line of incongruence, when adolescents reported lower family resilience than parents, adolescents had a lower level of psychological adjustment (a3=-1.02∼-0.45, p < 0.05). Adolescents' sociability decreased when the perceived family resilience of parent-adolescent dyads converged (a4 = 1.36, p < 0.01). CONCLUSION The findings highlighted the importance of considering the discrepancies and congruence of family resilience in the parent-child dyads when developing interventions to improve the psychological adjustment of adolescents with chronic illness. Interventions aimed at strengthening family communication to foster the convergence of perceptions of family resilience in parent-adolescent dyads were warranted.
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Affiliation(s)
- Meijia Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China
| | - Yuxin Wang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China
| | - Liping Zhang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
- Clinical Skills Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China.
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China.
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Walter LP, Göldel JM, Warschburger P. Originalarbeiten / Original Articles. Die protektive Rolle von Selbstregulation für die gesundheitsbezogene Lebensqualität bei Jugendlichen mit einer chronisch körperlichen Erkrankung / The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition. Prax Kinderpsychol Kinderpsychiatr 2024; 73:311-330. [PMID: 38840539 DOI: 10.13109/prkk.2024.73.4.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition A physical chronic condition comes with many challenges and negatively impacts the healthrelated quality of life (HRQOL) of those affected. Self-regulation plays an important role in successfully coping with the demands of a chronic condition. In line with a resource-oriented approach, this study aimed to investigate themoderating effect of self-regulation on the relationship between disease severity andHRQOL. For this, 498 adolescents with cystic fibrosis, juvenile idiopathic arthritis, or type-1 diabetes aged of 12-21 years (M= 15.43, SD= 2.07) were recruited through three patient registers. Subjective disease severity, self-regulation (Brief Self-Control- Scale), andHRQOL (DISABKIDSChronicGenericMeasure)were examined at two time points (T₁ and T₂, one year apart). Cross-sectional analysis showed significant effects of subjective disease severity and self-regulation on HRQOL. Prospective analysis, in which HRQOL at T₁ was controlled for, revealed that disease severity only predicted emotion-related HRQOL at T₂; selfregulation emerged as a predictor for HRQOL subscales independence, emotion, inclusion, exclusion, and treatment. A significantmoderation effect of self-regulation was found on the relationship between disease severity and HRQOL emotion. Our results highlight the positive impact of self-regulation on quality of life, specifically in the context of chronic conditions and represent a starting point for prevention and intervention approaches.
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Kammering H, Cruz JA, Platzbecker AL, Reinauer C, Förtsch K, Krassuski L, Viermann R, Domhardt M, Baumeister H, Staab D, Minden K, Mueller-Stierlin AS, Holl RW, Warschburger P, Meissner T. Motivational interviewing from the paediatricians' perspective: assessments after a 2-day training for physicians caring for adolescents with chronic medical conditions (CMCs). BMC Pediatr 2024; 24:355. [PMID: 38778341 PMCID: PMC11110176 DOI: 10.1186/s12887-024-04794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians' attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians' point of view. METHOD The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined. RESULTS Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians' experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow. CONCLUSIONS MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (DRKS00014043) on 26/04/2018.
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Affiliation(s)
| | | | | | | | | | | | | | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin and Charité - Universitätsmedizin, Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany
| | | | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Petra Warschburger
- Department Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
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6
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Lee SL, Wu LM, Lin SY, Chen TH, Lin WT. Cross-cultural translation and validation of the Chinese version Distress Tolerance Scale for adolescents with chronic physical disease. Child Care Health Dev 2024; 50:e13270. [PMID: 38706405 DOI: 10.1111/cch.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Chronic physical disease (CPD) makes life filled with many negative events in adolescents, but not all adolescents experiencing negative life events proceed to develop emotional distress, only those with low emotional distress tolerance (EDT). A valid and reliable scale to measure EDT in CPD adolescents is important for caring for their emotional distress. Therefore, the purpose of this study is to translate the 15-item English version Distress Tolerance Scale (DTS) into a Chinese version and then validate the scale for measuring EDT of adolescents with CPD. METHODS The 15-item English version DTS was translated into a Chinese version using the translation guidelines for cross-cultural research. Two cohorts of adolescents with CPD were recruited from four hospitals in southern Taiwan, with the first cohort including 124 adolescents with CPD employed to conduct exploratory factor analysis, corrected item-total correlation and reliability testing, while the second cohort, consisting of 238 adolescents with CPD, was utilized to examine confirmatory factor analysis and concurrent validity. RESULTS The two-factor nine-item Chinese version DTS for Adolescents with CPD (C-DTS-A) was developed. Lower scores of the C-DTS-A were significantly associated with higher diabetes distress, poorer self-management, and worse glycaemic control; their correlation coefficients sequentially were -.40, .17 and -.23. Cronbach's α and the test-retest reliability of the two-factor C-DTS-A ranged from .81 to .87 and from .79 to .89, respectively. CONCLUSION The two-factor nine-item C-DTS-A with good cross-cultural translation quality was a reliable and valid scale to assess EDT for adolescents with CPD.
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Affiliation(s)
- Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Han Chen
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neonatal Intensive Care Unit, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Koivusilta LK, Acacio-Claro PJ, Mattila VM, Rimpelä AH. Health and health behaviours in adolescence as predictors of education and socioeconomic status in adulthood - a longitudinal study. BMC Public Health 2024; 24:1178. [PMID: 38671433 PMCID: PMC11055384 DOI: 10.1186/s12889-024-18668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. METHODS Surveys on health and health behaviours were sent to representative samples of 12-18-year-old Finns in 1981-1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. RESULTS In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. CONCLUSION Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes.
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Affiliation(s)
- Leena K Koivusilta
- Department of Social Research, Faculty of Social Sciences, University of Turku, 20014, Turku, Finland.
| | - Paulyn Jean Acacio-Claro
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, and Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Arja H Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
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Cohn E, Mastacouris N, Palma G, Strunk A, Garg A. New-onset anxiety in paediatric patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024. [PMID: 38577863 DOI: 10.1111/jdv.19994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Affiliation(s)
- E Cohn
- Northwell Health, New Hyde Park, New York, USA
| | | | - G Palma
- Northwell Health, New Hyde Park, New York, USA
| | - A Strunk
- Northwell Health, New Hyde Park, New York, USA
| | - A Garg
- Northwell Health, New Hyde Park, New York, USA
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Schuchman M, Brady TM, Glenn DA, Tuttle KR, Cara-Fuentes G, Levy RV, Gonzalez-Vicente A, Alakwaa FM, Srivastava T, Sethna CB. Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies. J Nephrol 2024; 37:647-660. [PMID: 38512380 DOI: 10.1007/s40620-024-01919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies. METHODS An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes. RESULTS In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes. DISCUSSION/CONCLUSION Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.
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Affiliation(s)
- Matthew Schuchman
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Division of Nephrology, University of Washington School of Medicine, Spokane, WA, USA
| | - Gabriel Cara-Fuentes
- Section of Pediatric Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Rebecca V Levy
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Agustin Gonzalez-Vicente
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fadhl M Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI, USA
| | - Tarak Srivastava
- Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Christine B Sethna
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA.
- Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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10
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Förtsch K, Viermann R, Reinauer C, Baumeister H, Warschburger P, Holl RW, Domhardt M, Krassuski LM, Platzbecker AL, Kammering H, Cruz JA, Minden K, Staab D, Meissner T. The Impact of COVID-19 Pandemic on Mental Health of Adolescents With Chronic Medical Conditions: Findings From a German Pediatric Outpatient Clinic. J Adolesc Health 2024; 74:847-849. [PMID: 38206222 DOI: 10.1016/j.jadohealth.2023.11.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE The impact of the COVID-19 pandemic on the mental health of adolescents is of great concern, especially in the vulnerable group of adolescents with chronic medical conditions. The aim of this study was to examine this impact on the mental health of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic. METHODS Changes in the mental health status of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic during the COVID-19 pandemic were explored via validated screening tools for anxiety and depression. RESULTS The relative risk for adolescents with chronic medical conditions to develop clinically relevant symptoms of anxiety or depression was significantly higher (odds ratio 1,78 [confidence interval 1.06-3.04]) during the pandemic. DISCUSSION This study identifies the COVID-19 pandemic as a potential additional risk for adolescents with chronic medical conditions to develop clinically relevant signs of anxiety or depression.
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Affiliation(s)
- Katharina Förtsch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Rabea Viermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Lisa M Krassuski
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Lena Platzbecker
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hannah Kammering
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jennifer Antony Cruz
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
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11
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Shan Y, Wu J, Dai X, Yuan C, Jiang J, Yan H, Tang L, Dong Y, Ren L, Pan Q, Ji J, Zhao X. Jiangqi Pingxiao formula regulates dendritic cell apoptosis in an autophagy-dependent manner through the AMPK/mTOR pathway in a murine model of OVA-induced asthma. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117405. [PMID: 37952734 DOI: 10.1016/j.jep.2023.117405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Allergic asthma is a recurring respiratory condition that typically manifests during childhood or adolescence. It is characterized by a dominant type II immune response triggered by the identification and capturing of inhaled allergens by dendritic cells (DCs). Jiangqi Pingxiao Formula (JQPXF), a prescription medicine used for the treatment of pediatric asthma, has been clinically proven to be both safe and effective. However, its mechanism of action in the treatment of asthma has not been fully been fully elucidated. Recent research suggests that several natural compounds have the potential to target dendritic cells (DCs) and alleviate ovalbumin (OVA)-induced asthma, which may also be found within JQPXF. AIM OF THE STUDY This study aimed to elucidate the effect of JQPXF on OVA-induced asthma model and its molecular mechanism targeting DCs. MATERIALS AND METHODS The main constituents of JQPXF were analyzed by ultra performance liquid chromatography (UPLC). An asthma model was established by OVA. Hematoxylin-eosin staining and measurement of respiratory function was used to evaluate the treatment effect of JQPXF on asthmatic mice. Cytokine (IL-5, IL-13 and IgE) concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Flow cytometry was employed to evaluate inflammatory cell infiltration (T helper 2 cells and DCs) in vivo and DC survival in vivo and vitro. Western blot and immunofluorescence were used to verify the molecular mechanisms. RESULTS The results suggest that JQPXF can ameliorate pathological conditions and improve lung function in asthmatic mice, as well as the Th2 cells. Treatment with JQPXF significantly reduced the number of DCs and increased the number of Propidium iodide+ (PI) DCs. Furthermore, JQPXF upregulated protein levels of the pro-apoptotic factors Cleaved-caspase-3 and Bax, while downregulating the anti-apoptotic factor Bcl-2. Simultaneously, JQPXF increased autophagy levels by facilitating p62 degradation and promoting translation from LC3B I to LC3B II of DCs in vitro, as well as reducing the integrated optical density (IOD) of p62 within the CD11c-positive area in the lung. 3-Methyladenine (3-MA) was used to block autophagic flux and the apoptotic effect of JQPXF on DCs was abolished in vitro, with the number of DCs decreased by JQPXF being reversed in vivo. We further investigated the upstream key regulator of autophagy, the AMPK/mTOR pathway, and found that JQPXF increased AMPK phosphorylation while decreasing mTOR phosphorylation levels. Additionally, we employed Compound C (CC) as an AMPK inhibitor to inhibit this signaling pathway, and our findings revealed that both autophagic flux and apoptotic levels in DCs were abolished in vitro. CONCLUSIONS In summary, we have demonstrated that JQPXF could alleviate type II inflammation in an asthmatic model by promoting the apoptosis of DCs through an autophagy-dependent mechanism, achieved by regulating the AMPK/mTOR signaling pathway.
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Affiliation(s)
- Yiwen Shan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiabao Wu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohan Dai
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinjin Jiang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hua Yan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingling Tang
- School of Chinese Medicine & School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yingmei Dong
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lishun Ren
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingyun Pan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianjian Ji
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Xia Zhao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China.
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12
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Oh WO, Heo YJ, Han J, Lee E. Analyzing symptom experiences and pathways to enhancing quality of life in adolescents with Moyamoya disease. J Pediatr Nurs 2024; 75:72-79. [PMID: 38103460 DOI: 10.1016/j.pedn.2023.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE The psycho-emotional symptom experiences and health-related factors that influence the quality of life of adolescents with Moyamoya disease are still not fully understood. The aim of this study is to identify the daily physical and accompanying psychological symptom experiences of such adolescents, and to examine how health-related factors contribute to their quality of life. DESIGN AND METHOD This study employed a descriptive cross-sectional research design. Data on a total of 134 adolescents with Moyamoya disease was analyzed in order to develop a path analysis. Data were collected from October 2019 to January 2021 in South Korea. The theory of salutogenesis was employed in order to develop a hypothetical model for this path analysis. Participants were given a self-reporting questionnaire. Descriptive analysis and path analysis were conducted based on the results. RESULTS Adolescents with Moyamoya disease experienced several negative emotions simultaneously, regardless of the severity of their physical symptoms. The path analysis revealed that stress, a sense of coherence, behavior, and the support of friends were significant contributors to adolescents' quality of life. CONCLUSIONS Adolescents with Moyamoya disease have multifaceted symptom experiences in their daily lives. To enhance their quality of life, it is crucial to provide support that can help strengthen their capacity for stress management and enhance their sense of coherence. PRACTICAL IMPLICATIONS This study provides evidence that nurses should offer anticipatory information to adolescents with Moyamoya disease regarding the symptoms they will frequently encounter, and develop interventions to enhance their quality of life.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea.
| | - Yoo-Jin Heo
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea.
| | - Jihee Han
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea.
| | - Eunji Lee
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea.
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13
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Merlo EM, Tutino R, Myles LAM, Alibrandi A, Lia MC, Minasi D. Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study. Healthcare (Basel) 2024; 12:257. [PMID: 38275537 PMCID: PMC10815314 DOI: 10.3390/healthcare12020257] [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: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Type 1 diabetes mellitus (T1DM) represents a complex pathology affecting a large number of people. Research suggests that psychological factors influence coping with T1DM. This study aimed to investigate the presence and role of psychopathology, alexithymia and uncertainty in people affected by T1DM. The sample consisted of 137 patients (88 females, 49 males) affected by T1DM aged from 11 to 19 years old (Mean: 13.87; SD: 2.40). The diagnostic protocol consisted of a sociodemographic questionnaire, Self-administration Psychiatric Scales for Children and Adolescents (SAFA), Toronto Alexithymia Scale-20 (TAS-20) and Intolerance to Uncertainty Scale-12 (IUS-12). Descriptive, differential, correlational and regression analyses were performed in order to examine the relationships between these variables. The results suggested the sample had high levels of psychopathological indexes, alexithymia and intolerance of uncertainty. Also, there were significant differences between TAS-20 and IUS-12 distributions with respect to psychopathology. Correlations and multivariate linear regressions indicated age, gender and education significantly predicted alexithymia and intolerance of uncertainty. This data suggest the presence of elevated psychopathology, alexithymia and uncertainty in people with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
| | | | - Angela Alibrandi
- Department of Economics, University of Messina, 98122 Messina, Italy;
| | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
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14
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Postigo-Zegarra S, Schoeps K, Pérez-Marín M, Lacomba-Trejo L, Valero-Moreno S. Personal and family factors for emotional distress in adolescents with chronic disease. Front Psychol 2024; 14:1304683. [PMID: 38259579 PMCID: PMC10801719 DOI: 10.3389/fpsyg.2023.1304683] [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: 09/29/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Physical and psychological comorbidity is a challenge for public health, especially in the adolescent stage due to the difficulties of this age. The salutogenic perspective emphasizes general psychological resources such as self-esteem but also highlights the role of contextual factors such as family members in promoting health. From this perspective, the objective of this study was to analyze the joint influence of demographic factors (sex, age and type of chronic disease), personal factors (self-esteem and perception of threat of the disease) and family factors (affection and communication, psychological and behavioral control) of risk of emotional distress (anxiety-depressive symptoms) in chronically ill adolescents. Methods The study is a cross-sectional design with 495 adolescents with chronic disease aged 12-16 years. In order to obtain the results, a linear methodology was used to compare means and perform regressions to predict belonging to the anxiety and depression typologies. Four typologies were constructed: typology I (high anxiety and depression scores); typology II (high anxiety and low depression scores); typology III (low anxiety and high depression scores) and typology IV (low anxiety and depression scores). Results The results were consistent with the salutugenic theory. Potential mediating or moderating roles of age, sex, self-esteem, perceived threat and psychological and behavioral control marked the differences between the typologies. Discussion This population could benefit from interventions focused on family flexibility.
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Affiliation(s)
- Silvia Postigo-Zegarra
- Personality, Assessment and Psychological Department, Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
- Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | - Konstanze Schoeps
- Personality, Assessment and Psychological Department, Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Department, Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
| | - Laura Lacomba-Trejo
- Educational and Developmental Psychology Department, Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
| | - Selene Valero-Moreno
- Personality, Assessment and Psychological Department, Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
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15
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Mikola K, Rebane K, Kautiainen H, Aalto K. Transition readiness among finnish adolescents with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:149. [PMID: 38129898 PMCID: PMC10740281 DOI: 10.1186/s12969-023-00938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND With chronic diseases, the responsibility for care transfers to adult clinics at some point. Juvenile idiopathic arthritis (JIA) is the most common persistent rheumatic condition in children. A successful transition requires sufficient self-management skills to manage one´s chronic condition and all the tasks involved. In this study, we evaluated transition readiness in Finnish patients with JIA. We aimed to find practical tools to support a successful transition and to study the possible consequences of an unsuccessful transition. METHODS The usefulness of a specific questionnaire, which was administered to 83 JIA patients, was evaluated in this study. We also gathered information from their first adult clinic visit to assess the success of their transition and its relation to disease activity. RESULTS In 55 (71%) patients, the transition was estimated to be successful. We were able to determine a cut-off score in the questionnaire for a successful transition: the best estimate for a successful transition is when the score is 24 or more. At the first adult clinic visit, an unsuccessful transition was evident in its effect on disease outcome. If the transition was defined as successful, the DAS28 was better. CONCLUSION We found the questionnaire to be a useful tool for evaluating transition readiness. Determination of a successful transition helped us identify those adolescents who needed more profound support to improve their self-management skills and thus enhance their transition process. An unsuccessful transition was shown to negatively impact on disease outcomes.
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Affiliation(s)
- Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland.
| | - Katariina Rebane
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Kristiina Aalto
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland
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16
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O'Shea D, Schmoke N, Porigow C, Murray LP, Chung WK, Kattan M, Jang M, Antosy A, Middlesworth W, Khlevner J. Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review. J Pediatr Gastroenterol Nutr 2023; 77:703-712. [PMID: 37771007 DOI: 10.1097/mpg.0000000000003952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Infants born with esophageal atresia and tracheoesophageal fistula, a complex congenital malformation occurring in 1/2500-4000 live births, may suffer threats to their cardiac, respiratory, and digestive health in addition to anomalies that may exist in the genitourinary and musculoskeletal systems. Optimal care for these patients throughout their lives is best achieved through a coordinated, multidisciplinary approach that our health care system is not always well-equipped to provide. This review, though not exhaustive, highlights the components of care that pertain to initial surgical reconstruction and subsequent diagnosis and management of the complications that are most frequently encountered. Authors from among the many specialties involved in the care of these patients summarize the current best practice with attention to the most recent advances. Assessment and improvement of quality of life and transition to adult specialists as children grow to adulthood is also reviewed.
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Affiliation(s)
- Delia O'Shea
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Nicholas Schmoke
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Chloe Porigow
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Laurie P Murray
- the Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Wendy K Chung
- the Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY
| | - Meyer Kattan
- the Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Minyoung Jang
- the Department of Otolaryngology Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Alexandra Antosy
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - William Middlesworth
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Julie Khlevner
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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17
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Lupini F, Rubinstein TB, Mackey ER, Sule S. Behavioral health outcomes and social determinants of health in children with diabetes and juvenile arthritis. RESEARCH SQUARE 2023:rs.3.rs-3610878. [PMID: 38076886 PMCID: PMC10705696 DOI: 10.21203/rs.3.rs-3610878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective Children with chronic illnesses, including arthritis, are at increased risk for adverse psychosocial outcomes influenced by social determinants of health (SDOH). Comparing psychosocial outcomes in families affected by juvenile arthritis compared to other chronic illnesses may help identify areas in need of special attention vs areas that may be addressed through adopting other disease examples' care models. We examined child and parent behavioral health outcomes for families with juvenile arthritis compared to diabetes, accounting for SDOH. Methods Secondary data analysis of the National Survey of Children's Health including 365 children (<18yrs) with arthritis and 571 children with diabetes. Psychosocial outcomes were depression, anxiety, ADHD, physical pain, behavioral problems, and treatment for mental health. School outcomes were school engagement, school absence, involvement in clubs/organization, and involvement in organized activities. Parent outcomes were family resilience, emotional support, coping with daily demands of raising a child, job change due to problems with childcare, and parent mental health. SDOH variables were food insecurity, food/cash assistance, unsafe neighborhood, detracting neighborhood elements, parent education, households earning <100% of the federal poverty line. Logistic regression analyses were utilized to examine variation in child and parent outcomes, variation in SDOH, and the role of SDOH. Results Children with arthritis experienced significantly more physical pain, anxiety, depression, ADHD, and behavior problems compared to children with diabetes. Children with arthritis were more likely to see a mental health professional and get treatment for problems with emotions/behaviors. When considering SDOH, children with arthritis were still more likely to experience adverse psychosocial outcomes but were no longer more likely to get treatment. Children with arthritis had increased likelihood of school absence and were less involved in organized activities than children with diabetes. Parents of children with arthritis had poorer mental health than parents of children with diabetes. SDOH were more prevalent in children with arthritis than children with diabetes. Conclusions Increased risk for adverse psychosocial outcomes in youth with arthritis compared to youth with diabetes indicates a need to mirror endocrinology models of care in rheumatology clinics. The role of SDOH highlights the need for regular SDOH screening in clinic.
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Affiliation(s)
| | | | - Eleanor R Mackey
- Children's National Medical Center: Children's National Hospital
| | - Sangeeta Sule
- Children's National Medical Center: Children's National Hospital
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18
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Li S, Chen Z, Yong Y, Xie J, Li Y. Effectiveness of acceptance and commitment therapy-based interventions for improving the psychological health of parents of children with special health care needs: A systematic review and meta-analysis. Compr Psychiatry 2023; 127:152426. [PMID: 37757593 DOI: 10.1016/j.comppsych.2023.152426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of ACT-based interventions on improving the mental health of parents of children with SHCN compared to active/inactive controls and to investigate the characteristics/components of the effective interventions in the included studies. METHODS Eight databases were searched from inception to 14 February 2023. We included all randomized controlled trials (RCTs) of ACT-based interventions for parents of children with SHCN published in English or Chinese journals and dissertations reporting at least one parental mental health outcome postintervention. RESULTS Fourteen RCTs were included. The results indicated significant improvements of ACT-based interventions in the stress (Hedges' g = -0.36), depressive symptoms (g = -0.32), anxiety (g = -0.29), distress (g = -0.29), psychological flexibility (g = 0.51), mindful awareness/mindfulness abilities (g = 0.41), and confidence/self-efficacy (g = 0.30) of parents, as well as in the emotional and behavioural problems (EBP; g = -0.39) of their children with SHCN postintervention, with moderate to high certainty of evidence. Furthermore, the optimal components of ACT-based interventions, including the intervention approaches (ACT combined with another parenting technique/program), active participants (only involving parents), delivery mode (in-person) and format (group-based format), and desirable number of sessions (4-8 sessions), were identified to inform the design of future interventions/studies. CONCLUSION This review highlights the positive effects of ACT-based interventions on mental health, psychological flexibility, mindful awareness/mindfulness abilities, and confidence/self-efficacy in parents and EBP in children with SHCN. Since group-based ACT combined with a parenting technique/program was identified as the optimal effective strategy, its effects could be further examined in larger-scale RCTs with parents and children with SHCN with diverse ethnic and sociodemographic characteristics.
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Affiliation(s)
- Sini Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Zengyu Chen
- The Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yijing Yong
- Cognition and Human Behaviour Key Laboratory of Hunan Province, Hunan Normal University, Changsha, Hunan, China
| | - Jiao Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China..
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; The Xiangya Nursing School, Central South University, Changsha, Hunan, China.
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Feng J, Cai M, Qian ZM, Zhang S, Yang Y, McMillin SE, Chen G, Hua J, Tabet M, Wang C, Wang X, Lin H. The effects of long-term exposure to air pollution on incident mental disorders among patients with prediabetes and diabetes: Findings from a large prospective cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 897:165235. [PMID: 37414192 PMCID: PMC10522921 DOI: 10.1016/j.scitotenv.2023.165235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The association between air pollution and mental disorders has been widely documented in the general population. However, the evidence among susceptible populations, such as individuals with prediabetes or diabetes, is still insufficient. METHODS We analyzed data from 48,515 participants with prediabetes and 24,393 participants with diabetes from the UK Biobank. Annual pollution data were collected for fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), and nitrogen dioxides (NOx) during 2006-2021. The exposure to air pollution and temperature for each participant were estimated by the bilinear interpolation approach and time-weighted method based on their geocoded home addresses and time spent at each address. We employed the generalized propensity score model based on the generalized estimating equation and the time-varying covariates Cox model to assess the effects of air pollution. RESULTS We observed causal links between air pollutants and mental disorders among both prediabetic and diabetic participants, with stronger effects among those with diabetes than prediabetes. The hazard ratios were 1.18 (1.12, 1.24), 1.15 (1.10, 1.20), 1.18 (1.13, 1.23), and 1.15 (1.11, 1.19) in patients with prediabetes, and 1.21 (1.13, 1.29), 1.17 (1.11, 1.24), 1.19 (1.13, 1.25), and 1.17 (1.12, 1.23) in patients with diabetes per interquartile range elevation in PM2.5, PM10, NO2, and NOx. Furthermore, the effects were more pronounced among people who were older, alcohol drinkers, and living in urban areas. CONCLUSIONS Our study indicates the potential causal links between long-term exposure to air pollution and incident mental disorders among those with prediabetes and diabetes. Reducing air pollution levels would significantly benefit this vulnerable population by reducing the incidence of mental disorders.
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Affiliation(s)
- Jin Feng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Yin Yang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Stephen Edward McMillin
- School of Social Work, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, Saint Louis, MO 63103, USA
| | - Ge Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Junjie Hua
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, Saint Louis, MO 63110, USA
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
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20
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Green C, Leyenaar JK, Leslie LK. Association Between Educational Resources and Pediatric Fellows' Mental Health Attitudes and Self-Reported Competence. Acad Pediatr 2023; 23:1628-1635. [PMID: 37524164 DOI: 10.1016/j.acap.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND/OBJECTIVES Children with chronic medical conditions (CCMC) have high rates of mental health (MH) conditions. This study examines associations between MH educational resources during fellowship and 3 dependent variables: fellows' interest, perceived responsibility, and self-reported competence in assessing MH concerns of CCMC. METHODS Subspecialty fellows taking the American Board of Pediatrics in-training examinations in February 2020 were invited to participate in a survey inquiring about MH educational resources. Logistic regression examined associations between MH educational resources and the 3 dependent variables, adjusting for demographics and program-level characteristics. RESULTS Of the 97.7% (4216) fellows who responded, 3870 were included in analyses. About 37.5% reported formal MH teaching sessions; 36.7% reported on-site MH professionals engaged in teaching; 41.6% reported co-assessing patients with MH specialists; and 28.3% reported performance evaluation of their MH skills. All 4 resources were significantly and positively associated with self-reported competence in adjusted analyses, with odds ratios (OR) ranging from 1.28 (95% confidence interval (95% CI): 1.03-1.58) for formal teaching sessions to 2.14 (95% CI: 1.73-2.65) for performance evaluation. Resources were positively associated with the dependent variables in a "dose-response" pattern. Respondents who reported having all 4 educational resources compared to zero resources had an OR of 2.20 (95% CI: 1.74-2.78) for high MH interest, 3.18 (95% CI: 2.45-4.12) for high perceived responsibility, and 4.38 (95% CI: 3.43-5.60) for high self-reported competence CONCLUSIONS: Access to mental health educational resources was associated with higher interest, perceived responsibility, and self-reported competence; investing in these resources may improve fellows' skills in addressing the emotional needs of CCMC.
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Affiliation(s)
- Cori Green
- Weill Cornell Medicine (C Green), New York, NY.
| | - JoAnna K Leyenaar
- Department of Pediatrics and The Dartmouth Institute for Health Policy & Clinical Practice (JK Leyenaar), Dartmouth-Hitchcock Medical Center, Hanover, NH
| | - Laurel K Leslie
- American Board of Pediatrics (LK Leslie), Chapel Hill, NC; Tufts School of Medicine (LK Leslie), Boston, Mass
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21
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Thomsen EL, Boisen KA, Andersen A, Jørgensen SE, Teilmann G, Michelsen SI. Low Level of Well-being in Young People With Physical-Mental Multimorbidity: A Population-Based Study. J Adolesc Health 2023; 73:707-714. [PMID: 37389522 DOI: 10.1016/j.jadohealth.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We aimed to examine whether wellbeing, health behavior, and youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions. METHODS The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index and life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis. RESULTS A total of 52% of YP with physical-mental multimorbidity reported a low level of wellbeing, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical conditions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions. DISCUSSION YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings.
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Affiliation(s)
- Ena Lindhart Thomsen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark, Copenhagen, Denmark.
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | | | - Grete Teilmann
- Department for Children and Adolescents, Nordsjaellands Hospital, Hilleroed, Denmark
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22
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Burrell TD, Kim S, Mohadikar K, Jonas C, Ortiz N, Horberg MA. Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic. J Adolesc Health 2023; 73:693-700. [PMID: 37032208 PMCID: PMC10081921 DOI: 10.1016/j.jadohealth.2023.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/19/2022] [Accepted: 01/21/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. METHODS Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. RESULTS Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic. DISCUSSION Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.
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Affiliation(s)
- Tierra D Burrell
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Department of Pediatrics, MAPMG, Rockville, Maryland.
| | - Seohyun Kim
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Karishma Mohadikar
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Cabell Jonas
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Nancy Ortiz
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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23
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Thavamani A, Sterling N, Umapathi KK, Sankararaman S. Prevalence and impact of psychiatric disorders on hospitalized pediatric patients with chronic pancreatitis. Pancreatology 2023; 23:574-581. [PMID: 37391358 DOI: 10.1016/j.pan.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/03/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Patients with chronic pancreatitis (CP) often have a debilitating clinical course characterized by high disease burden, and poor quality of life and these factors adversely affect mental health. However, there is paucity of literature on the prevalence and impact of psychiatric disorders on hospitalized pediatric patients with CP. METHOD ology: We analyzed the Kids Inpatient Database, and National Inpatient Sample, between 2003 and 2019 and included patients up to 21 years of age. Pediatric CP patients with psychiatric disorders were compared with patients without any of the psychiatric disorders using the ICD diagnostic codes. Various demographic and clinical factors were compared between the groups. Length of hospitalization and total hospital charges were used as surrogates to compare the hospital resource utilization between the groups. RESULTS We analyzed a total of 9,808 hospitalizations with CP and the overall prevalence rate of psychiatric disorders was 19.8%. The prevalence rate increased from 19.1% in 2003 to 23.4% in 2019, p = 0.006. The peak prevalence rate of 37.2% was noted at 20 years of age. Depression was noted at 7.6% of the total hospitalizations followed by substance abuse (6.5%), and anxiety (4.4%). Multivariate linear regression analysis showed that among CP patients, psychiatric disorders were independently associated with 1.3 additional days of stay and incurred $15,965 higher charges. CONCLUSIONS The prevalence of psychiatric disorders is increasing in pediatric CP. The concomitant presence of psychiatric disorders was found to be associated with prolonged hospital stay and incurred higher healthcare charges than those CP patients without psychiatric disorders.
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Affiliation(s)
- Aravind Thavamani
- Department of Pediatrics (Division of Pediatric Gastroenterology), UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
| | - Neya Sterling
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | | | - Senthilkumar Sankararaman
- Department of Pediatrics (Division of Pediatric Gastroenterology), UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
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24
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Thavamani A, Velayuthan S, Patel D, Al-Hammadi N, Sferra TJ, Sankararaman S. Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome. Am J Gastroenterol 2023; 118:1439-1445. [PMID: 37052354 DOI: 10.14309/ajg.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sujithra Velayuthan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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25
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Seifaei A, Askarinejad A, Bazrafshan Drissi H, Keshtvarz Hesam Abadi A, Sasannia S, Moghadami M, Izadpanah P, Bazrafshan H. General Anxiety Disorder and Primary Hypertension: Is There a Link? J Nerv Ment Dis 2023; 211:525-529. [PMID: 37166043 DOI: 10.1097/nmd.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
ABSTRACT Chronic forms of morbidity, including mental disorders and hypertension, play a dominant role in determining a disease load in the developing world. This article investigates the associations between the diagnoses of primary hypertension and generalized anxiety disorder (GAD) and the severity of GAD in individuals with primary hypertension. The association of GAD and age, sex, marriage, education level, income, chronic medical conditions, family history of mental disorders, adverse life events, and hypertension was assessed in 470 patients with the diagnosis of primary hypertension. Data analysis was performed with IBM SPSS Statistics software version 16. A significant relationship was found between the prevalence of GAD and the following variables: history of mental disorders ( p < 0.0001), chronic medical conditions ( p < 0.0001), and adverse life events ( p < 0.0001). The mean anxiety score was higher among patients with uncontrolled blood pressure, and a significant relationship was observed between the prevalence of GAD and blood pressure ( p < 0.0001). Because of the significant association between GAD and primary hypertension, it is recommended that anxiety disorders be considered in patients in whom primary hypertension is not controlled easily. This may lead to more proper control of hypertension while taking fewer antihypertensive medications.
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Affiliation(s)
| | | | | | | | | | | | - Peyman Izadpanah
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Chandrasekar H, Sinclair-McBride K, Lee EH, Iqbal MB, Gauvreau K, Barkas I, Newburger JW, DeMaso DR, Saleeb SF. Feasibility and Caregiver Receptiveness to Anxiety Screening in Pediatric Cardiology Clinic: A Pilot Study. Clin Pediatr (Phila) 2023; 62:597-604. [PMID: 36461155 DOI: 10.1177/00099228221134559] [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: 12/04/2022]
Abstract
Children with chronic medical conditions, including heart disease, have increased susceptibility to behavioral health concerns. We sought to evaluate the feasibility and parental opinion of anxiety screening in pediatric cardiology clinic. The PROMIS Pediatric Anxiety v2.0 Short Form 8a (PA2-S8) questionnaire was administered to 48 patients presenting to pediatric cardiology clinic for follow-up care. Parents/caregivers were asked their opinion on anxiety screening in cardiology clinic. The survey was completed by 47 out of 48 participants (median age 13, range 9-17). Fourteen (30%) participants had scores suggestive of increased anxiety symptomatology. No trends were identified between PA2-S8 score and age at diagnosis (P = .13), age at survey administration (P = .28), number of lifetime procedures (P = .89), number of noncardiac specialists (P = .13), or underlying cardiac diagnoses (P = .55). Most families (76%) were in favor of the screening effort. This study suggests that anxiety screening in cardiology clinic is both feasible and well-received by families.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatric Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Keneisha Sinclair-McBride
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica H Lee
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mudassera B Iqbal
- Massachusetts General Physician Organization Ambulatory Management, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ioanna Barkas
- Department of Pediatrics, Hasbro Children's Hospital and Brown University, Providence, RI, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - David R DeMaso
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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27
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Alkhateeb AM. Burden and risk factors of anxiety disorders among Arabic pediatric population: A systematic review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
<b>Aim:</b> In the general population, where 6 to 20% of individuals experience anxiety disorders, children also experience a higher burden of anxiety. We undertook a systematic review In order to examine and summarize the results from studies that estimated the prevalence of anxiety and/or its associated risk factors in the pediatric populations of Arab nations, primarily the gulf countries.<br />
<b>Methods:</b> Any study that focused on the pediatric population and completed in Arab nations to determine the incidence of anxiety and/or its risk factors among children under the age of 18. The review had 13 articles were included.<br />
<b>Results:</b> The results of the systematic review found that there was a wide variation in the prevalence of anxiety among children. At least 30.2% of the children were found to suffer from anxiety and the prevalence could go up to 60% in some countries with a higher prevalence among girls than boys. Associated factors of anxiety were diverse including exposure to environmental tobacco smoke, parenting style, living with parents suffering from mental disorders, school type, and being female.<br />
<b>Conclusion:</b> The findings of the review demonstrate the higher prevalence of anxiety among children as almost at least one-third of children suffer from anxiety in the Gulf countries. The program managers and the respective government of these Arab countries need to devise some strategies and interventions that not only focus on the children but also their environment.
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Affiliation(s)
- Afnan M Alkhateeb
- Department of Physical Therapy, Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, SAUDI ARABIA
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28
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Mental Health and Health-Related Quality of Life in Austrian Adolescents with Chronic Physical Health Conditions: Results from the MHAT Study. J Clin Med 2023; 12:jcm12051927. [PMID: 36902714 PMCID: PMC10003709 DOI: 10.3390/jcm12051927] [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: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
Chronic physical health conditions (CPHC) are on the rise in younger age groups and might have a negative impact on children and adolescents. In a representative sample of Austrian adolescents aged 10-18 years, internalizing, externalizing, and behavioral problems were assessed cross-sectionally using the Youth Self-Report and health-related quality of life (HrQoL) using the KIDSCREEN questionnaire. Sociodemographic variables, life events, and chronic illness specific parameters were considered as associated variables with mental health problems in individuals with CPHC. Of 3469 adolescents, 9.4% of girls and 7.1% of boys suffered from a chronic pediatric illness. Of these individuals, 31.7% and 11.9% had clinically relevant levels of internalizing and externalizing mental health problems, respectively, compared to 16.3% and 7.1% adolescents without a CPHC. Anxiety, depression, and social problems were twice as high in this population. Medication intake due to CPHC and any traumatic life-event were related to mental health problems. All HrQoL domains were deteriorated in adolescents with a double burden of mental and CPHC, whereas adolescents with a CPHC without mental health problems did not differ significantly from adolescents without a chronic illness. Targeted prevention programs for adolescents with a CPHC are urgently needed to prevent mental health problems in the long term.
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29
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Anxiety among pediatric asthma patients and their parents and quick-reliever medication use: The role of physical activity parenting behaviours. World Allergy Organ J 2023; 16:100733. [PMID: 36744050 PMCID: PMC9874065 DOI: 10.1016/j.waojou.2022.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 01/23/2023] Open
Abstract
Background Clinical guidelines recommend the identification of asthma comorbidities, especially treatable problems such as parental behaviours and child and parent anxiety. Purpose We aimed to (1) explore associations of asthma severity with child and parent state anxiety, trait anxiety, and asthma-related anxiety as well as with caregiver behaviours around physical activity and (2) explore if caregiver behaviours around physical activity were associated with use of inhaled β-Agonists when symptomatic, and with child and parent anxiety. Patients and methods Patients ages 3-17 years with asthma (n = 72) and their parents were recruited from the Pulmonology-Allergology Pediatric clinic University Hospital Centre Split in Split, Croatia during 2021. During a clinical visit, the pharmacological regimen was assessed and spirometry was performed. Children completed the State-Trait Anxiety Inventory for Children (STAI-C) and the Youth Asthma-Related Anxiety Scale (YASS). Parents completed the State-Trait Anxiety Inventory (STAI), the Parent Asthma-Related Anxiety Scale (PASS), and the Physical Activity Parenting Practices - Short Form (PAPP). Results Most patients had mild asthma (69.4%). Children with moderate to severe asthma had increased asthma-related anxiety (mean = 11.94 ± 6.1) compared with children with mild asthma (mean = 5.97 ± 6.39, p = 0.003). Parents of children with mild asthma reported behaviours allowing unsupervised physical activity outside more often when compared to parents of children with moderate or severe asthma. Physical activity facilitation parenting behaviour reduced the odds of a child's need for quick-reliever medication when symptomatic (OR = 0.376,95% CI = -1.885 to -0.072; p = 0.034); more coercive parenting increased the odds of a child's additional use of such medications (OR = 2.602; 95% CI = 0.005 to 1.908; p = 0.049). Parents of children in the highest quartile of trait anxiety showed less non-directive support (1.97 ± 1.01 vs. 2.89 ± 1.19, p = 0.031) and less autonomy support (3.14 ± 1.32 vs. 4.11 ± 1.23, p = 0.037) of physical activity in their children than those with less trait anxiety. Conclusion Asthma-related anxiety was an important construct in this sample of children, associated with their disease severity as well as their parent's behaviours around the child's physical activities. Current research, conducted during the COVID-19 pandemic, recognised the tangible ways that parents support or avoid the asthmatic children's physical activity participation. Child anxiety and recognised parental physical activity behaviours are potentially important factors to assess and target for intervention.
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30
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Imbulana DI, White M, Hiscock H, Price AMH. The feasibility of identifying financial hardship in a tertiary paediatric setting, and associations with caregiver and child mental health. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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31
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Arp L, Jansson S, Wewer V, Burisch J. Psychiatric Disorders in Adult and Paediatric Patients With Inflammatory Bowel Diseases - A Systematic Review and Meta-Analysis. J Crohns Colitis 2022; 16:1933-1945. [PMID: 35775920 DOI: 10.1093/ecco-jcc/jjac095] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel diseases [IBD], which are associated with a high disease burden, are also reported to be accompanied by a high prevalence of psychiatric disorders. However, the literature on IBD and psychiatric disorders has not been reviewed. METHODS This systematic review followed the PRISMA guidelines, and its protocol was registered at PROSPERO [ID: CRD42020214359]. PubMed, Embase and PsycINFO were consulted for the literature search. Studies reporting on diagnosed psychiatric disorders in IBD were included. Pooled prevalence rates were calculated using random effects meta-analyses. Study quality was assessed using the Newcastle-Ottawa Scale [NOS]. RESULTS Sixty-nine studies were identified with an average cohort size of 60 114 patients. Pooled prevalence rates were: mood disorders, 10% (95% confidence interval [CI] = 7%; 15%); anxiety disorders, 12% [95% CI = 8%; 18%]; substance misuse, 3% [95% CI = 1%; 7%]; psychotic disorders, 2% [95% CI = 1%; 4%]; behavioural disorders, 1% [95% CI = 0%; 3%]; personality disorders, 3% [95% CI = 1%; 10%]; developmental disorders, 1% [95% CI = 0%; 3%]; and behavioural and emotional disorders with onset usually during childhood, 1% [95% CI = 1%; 3%]. All analyses had high statistical heterogeneity [I2 > 99%]. Seven studies reported an increased risk of suicide in IBD patients compared to controls. CONCLUSION The prevalence of psychiatric comorbidities was high [11-82%] in patients with IBD and was higher than in the background population. Addressing mental health problems in patients with IBD can improve their adherence to treatment and the somatic disease course and, consequently, reduce morbidity and mortality.
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Affiliation(s)
- Laura Arp
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Sabine Jansson
- Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Paediatric Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Vibeke Wewer
- Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Paediatric Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Ride J, Cameron L, Jones R, Dalziel K, Wurzel D, Kao KT, Freeman JL, Hiscock H. Preferences of parents for mental health services to suit children with chronic medical conditions. AUST HEALTH REV 2022; 46:722-730. [PMID: 36192367 DOI: 10.1071/ah22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
Objectives To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Lachlan Cameron
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Renee Jones
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia; and Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Danielle Wurzel
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic., Australia; and Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Respiratory Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Diabetes Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Jeremy L Freeman
- Respiratory Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia; and Department of Neurology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia
| | - Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia; and Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Health Services Research Unit, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia
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Correale C, Falamesca C, Tondo I, Borgi M, Cirulli F, Truglio M, Papa O, Vagnoli L, Arzilli C, Venturino C, Pellegrini M, Manfredi V, Sterpone R, Grimaldi Capitello T, Gentile S, Cappelletti S. Depressive Anxiety Symptoms in Hospitalized Children with Chronic Illness during the First Italian COVID-19 Lockdown. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1156. [PMID: 36010047 PMCID: PMC9406639 DOI: 10.3390/children9081156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
Abstract
COVID-19 is continuing to spread around the world, having a direct impact on people's daily lives and health. Although the knowledge of the impact of the COVID-19 pandemic on mental health in the general population is now well established, there is less information on its effect on specific and vulnerable populations, such as children with chronic illness (CI). We conducted a multi-centered cross-sectional study among pediatric patients in six public children's hospitals in Italy during the first lockdown, with the aim of assessing the proportion of children with CI presenting anxiety and depressive symptoms, and the clinical and demographic characteristics affecting such symptomatology. We included children with at least one chronic condition, with no cognitive delay, aged between 11 and 18 years. Brief standardized questionnaires were administered during medical scheduled visits to screen anxiety and depressive symptoms. We found a very high proportion of children showing mild to severe depressive and anxiety symptomatology (approximately 68% and 63%, respectively). Our results highlight the need of ensuring tailored psychological interventions to protect children with CI from the effect of the pandemic (and related restrictive measures such as quarantine and social distancing), with the final aim of promoting mental health and psychological well-being in this vulnerable population.
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Affiliation(s)
- Cinzia Correale
- Clinical Psychology Unit, IRCCS Bambino Gesù Children Hospital, 00146 Rome, Italy; (C.F.); (I.T.); (T.G.C.); (S.C.)
| | - Chiara Falamesca
- Clinical Psychology Unit, IRCCS Bambino Gesù Children Hospital, 00146 Rome, Italy; (C.F.); (I.T.); (T.G.C.); (S.C.)
| | - Ilaria Tondo
- Clinical Psychology Unit, IRCCS Bambino Gesù Children Hospital, 00146 Rome, Italy; (C.F.); (I.T.); (T.G.C.); (S.C.)
| | - Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
| | - Mauro Truglio
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand;
| | - Oriana Papa
- Children’s Neuropsychiatric Ward, Regional Pediatric Hospital “G. Salesi”, 60123 Ancona, Italy;
| | - Laura Vagnoli
- Pediatric Psychology, Meyer Children’s Hospital, 50139 Florence, Italy; (L.V.); (C.A.)
| | - Cinzia Arzilli
- Pediatric Psychology, Meyer Children’s Hospital, 50139 Florence, Italy; (L.V.); (C.A.)
| | | | - Michele Pellegrini
- Azienda Ospedaliera Universitaria Policlinico—Giovanni XXIII, 70124 Bari, Italy;
| | - Valentina Manfredi
- Psychology Unit, A.O. S.S. Antonio Biagio and C. Arrigo Hospital, 15121 Alessandria, Italy; (V.M.); (R.S.)
| | - Rossella Sterpone
- Psychology Unit, A.O. S.S. Antonio Biagio and C. Arrigo Hospital, 15121 Alessandria, Italy; (V.M.); (R.S.)
| | - Teresa Grimaldi Capitello
- Clinical Psychology Unit, IRCCS Bambino Gesù Children Hospital, 00146 Rome, Italy; (C.F.); (I.T.); (T.G.C.); (S.C.)
| | | | - Simona Cappelletti
- Clinical Psychology Unit, IRCCS Bambino Gesù Children Hospital, 00146 Rome, Italy; (C.F.); (I.T.); (T.G.C.); (S.C.)
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Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness. CHILDREN 2022; 9:children9071051. [PMID: 35884035 PMCID: PMC9316756 DOI: 10.3390/children9071051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
An estimated one in six children in the United States suffers from a mental disorder, including mood, anxiety, or behavioral disorders. This rate is even higher in children with chronic medical illness. This manuscript provides a concise review of the symptoms that comprise mental conditions often observed in children with chronic illness or at the end of life. It further provides some guidance to help clinicians distinguish normative from pathological presentations. Evidence-based psychotherapy interventions, potentially applicable to the acute inpatient setting, are briefly summarized. Broad recommendations are made regarding both psychotherapeutic as well as pharmacotherapeutic interventions, with a review of common or serious medication side effects. Finally, delirium recognition and management are summarized.
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Hood AM, Crosby LE, Stotesbury H, Kölbel M, Kirkham FJ. Considerations for Selecting Cognitive Endpoints and Psychological Patient-Reported Outcomes for Clinical Trials in Pediatric Patients With Sickle Cell Disease. Front Neurol 2022; 13:835823. [PMID: 35800079 PMCID: PMC9253275 DOI: 10.3389/fneur.2022.835823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Pediatric patients with sickle cell disease (SCD) experience a range of medical complications that result in significant morbidity and mortality. Recent advances in prophylactic and curative treatment approaches have highlighted the need for sensitive and clinically-meaningful trial endpoints. The detrimental effects of cognitive and psychological difficulties on social and economic mobility are well described. Although numerous reviews have assessed cognitive outcomes in other rare genetic disorders, SCD has not received the same focus. This review describes the cognitive (i.e., executive function and processing speed) and psychological domains (i.e., depression and anxiety) that are consistently associated with SCD pathology and, therefore, may be of particular interest as clinical trial endpoints. We then discuss corresponding well-validated and reliable cognitive tests and patient-reported outcomes (PROs) that may be appropriate for clinical trials given their robust psychometric properties, ease of administration, and previous use in the SCD population. Further, we provide a discussion of potential pitfalls and considerations to guide endpoint selection. In line with the move toward patient-centered medicine, we identify specific tests (e.g., NIH Toolbox Cognition Module, Wechsler Cancellation Test) and psychological PROs (e.g., PROMIS depression and anxiety scales) that are sensitive to SCD morbidity and have the potential to capture changes that are clinically meaningful in the context of patients' day to day lives. In particularly vulnerable cognitive domains, such as executive function, we highlight the advantages of composite over single-test scores within the context of trials. We also identify general (i.e., practice effects, disease heterogeneity) and SCD-specific considerations (i.e., genotype, treatment course, and disease course, including degree of neurologic, pain, and sleep morbidity) for trial measures. Executive function composites hold particular promise as trial endpoints that are clinically meaningful, amenable to change, relatively easy to collect, and can be incorporated into the routine care of patients with SCD in various settings and countries.
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Affiliation(s)
- Anna M. Hood
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Cunningham S, Campbell K, Miller T, Winter S, Presson A, Ou Z, Glotzbach K. Anxiety symptoms and associated functional impairment in children with CHD in a neurodevelopmental follow-up clinic. Cardiol Young 2022; 33:1-8. [PMID: 35723019 PMCID: PMC10704710 DOI: 10.1017/s1047951122001767] [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: 11/07/2022]
Abstract
OBJECTIVES To examine the prevalence of anxiety symptoms and associated functional impairment to adaptive skills among elementary-aged children with CHD and to determine the need for anxiety screening in this high-risk population. STUDY DESIGN In a single-centre retrospective, cohort design, caregivers reported anxiety symptoms using Conner's scales and functional impairment to adaptive skills using the Adaptive Behavior Assessment System. A total of 194 children were stratified across two cohorts: early elementary (ages 3-6 years) and late elementary (ages 6-14 years). Descriptive statistics summarised the frequency of anxiety symptoms and functional impairment. Spearman's correlations compared anxiety symptoms to functional impairment of adaptive functioning. Univariable logistic regressions examined demographic and clinical characteristics associated with anxiety symptoms. RESULTS The majority of patients presented with anxiety, early elementary (63%), and late elementary cohorts (78%). Functional impairment was moderately correlated with anxiety symptoms in the early elementary cohort (rs = -.42, 95% CI [-0.58, -0.21], p = <.001). Greater anxiety symptoms were associated with lower cardiac complexity at primary age of surgery in the late elementary cohort (OR = 12.15, p = 0.019). Lesser anxiety symptoms were associated with having private insurance (OR = 0.25, p = 0.014). CONCLUSION This study demonstrates anxiety symptoms are common and associated with functional impairment to adaptive functioning in younger children with CHD. No clear clinical predictors exist for anxiety symptoms or functional impairment; therefore, screening for anxiety symptoms may need to be added to standard clinical assessment of all children with CHD participating in neurodevelopmental follow-up.
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Affiliation(s)
- Sean Cunningham
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kathleen Campbell
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Miller
- Department of Cardiology, Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Sarah Winter
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Kristi Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
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Rahmat S, O'Connor R, Qayyum Z. Transitional-Age Youth With Chronic Medical and Mental Health Conditions. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220525-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Childhood Adversity and Illness Appraisals as Predictors of Health Anxiety in Emerging Adults with a Chronic Illness. J Clin Psychol Med Settings 2022; 30:143-152. [PMID: 35461438 PMCID: PMC9034695 DOI: 10.1007/s10880-022-09870-z] [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] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
Emerging adults with a chronic medical condition (CMC) are at increased risk for developing health anxiety (HA). Adverse childhood experiences (ACEs) have been linked to developing HA. CMCs and ACEs frequently co-occur among emerging adults. However, no known research has examined ACEs and HA within this critical developmental period. Further, increased negative illness appraisals (e.g., uncertainty, intrusivness) may partially explain the relation between ACEs and HA. The present study examined the following mediation model: ACEs → illness appraisals → HA. Emerging adults (N = 121) with a CMC completed self-report measures of demographics, ACEs, illness appraisals, and HA. Regression analyses were conducted to test each illness appraisal as a mediator between ACEs and HA. Results demonstrated significant indirect effects for both illness appraisals. Findings demonstrate greater ACEs may increase negative illness appraisals which heightens overall HA. Thus, these associations support trauma-informed care approaches to support emerging adults.
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Yang Y, Reyes BL, Jacob E. Health status, healthcare, and access in children with long-term medication use and difficulties with emotion, concentration, and behavior. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:240-249. [PMID: 35368132 DOI: 10.1111/jcap.12371] [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: 11/06/2020] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
PROBLEM Children with chronic conditions often have difficulties with emotions, concentration, and behaviors (ECB) and are not recognized and treated adequately. In this paper, long-term medication use (LTM) was adopted as a proxy for chronic illness due to the lack of consistent and standardized diagnostic criteria for chronic illnesses in children. METHODS Children (8-12 years) were selected from the California Health Interview Survey (2017) based on: (1) households with children (<12 years), (2) parent/adult caregivers report about child's health indicating "yes" to, (3) "does your child require prescription medicine for a health condition that has lasted or is expected to last at least 12 months or more," and (4) "difficulties with ECB in past 6 months." FINDINGS A total of 1600 children were included by the CHIS data set, and children whose parental report had met the selection criteria were children with LTM (n = 144; 7.4 ± 2.9 years), ECB (n = 233; 8.16 ± 2.14), and both LTM + ECB (n = 62; 8.61 ± 1.81). Children with LTM+ ECB were Caucasian (56.4%), Hispanic (19.3%), and males (64.5%). Children with both LTM + ECB had two to three (33.87%) or at least four (53.2%) physician visits, and/or receiving special therapy (45.1%). Children with LTM had prescription delays (n = 144; 5.6%) and were not able to get medical care due to lack of insurance (n = 144; 6.9%). The majority of the children with LTM (54.2%) and LTM + ECB (43.5%) had parental employment-based insurance. More children that have both LTM and ECB (48.4%) than children with LTM, No ECB (32.9%) were on Medi-Cal/Medicaid. CONCLUSION Children with LTM need further evaluation for difficulties with ECB. Future studies are required to examine health status, healthcare use, and access for children with LTM and ECB.
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Affiliation(s)
- Yuyin Yang
- UCLA Department of Psychology, Los Angeles, California, USA
| | - Beck L Reyes
- UCLA Adolescent Epilepsy Center, Los Angeles, California, USA
| | - Eufemia Jacob
- UCLA School of Nursing, Los Angeles, California, USA
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Taşar S, Dikmen N, Bulut İ, Haskılıç YE, Saç RÜ, Şenes M, Taşar MA, Taşar M. Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery. Cardiol Young 2022; 33:1-7. [PMID: 35361291 DOI: 10.1017/s1047951122001081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM This study aimed to provide baseline information on the potential role of salivary cortisol in reflecting the stress response in children undergoing congenital heart surgery. PATIENTS AND METHODS Children underwent congenital cardiac surgery, aged between one and seventeen years were included. Saliva samples were collected pre- and postoperatively by the health caregiver immediately after the children woke up (07:00-09:00 am) and at 06:00 pm in the evening. Salivary cortisol levels were compared with the reference index values from a large database. RESULTS Median baseline preoperative morning salivary cortisol levels were significantly lower than the reference values in both < 5-year-old females (p = 0.01) and males (p = 0.04) and in males between 11 and 20 years of age (p = 0.01). Median baseline preoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5 and 10 years of age (p = 0.04) and in between 11- and20-year-old males (p = 0.01). Median postoperative morning salivary cortisol levels were significantly lower than the reference value in both < 5-year-old females (p = 0.01) and males (p = 0.04) and females between 5 and 10 year of age (p = 0.04). Median postoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5- and 10-year-old females (p = 0.04). CONCLUSION Diurnal variability of salivary cortisol levels in children undergoing congenital heart surgery may be different from normal reference values both in preoperative and postoperative periods that can be a predictive indicator of anxiety on pre- and postoperative period for children that undergoing cardiac surgery.
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Affiliation(s)
- Serçin Taşar
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara, Turkey
| | - Nur Dikmen
- Department of Pediatric Cardiovascular Surgery, Dr.Sami Ulus Maternity, Child Health and Disease Education and Research Hospital, Ankara, Turkey
| | - İsmail Bulut
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara, Turkey
| | - Yunus Emre Haskılıç
- Department of Biochemistry, Ankara Education and Research Hospital, Ankara, Turkey
| | - Rukiye Ünsal Saç
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mehmet Şenes
- Department of Biochemistry, Ankara Education and Research Hospital, Ankara, Turkey
| | - Medine Ayşin Taşar
- Department of Pediatric Emergency, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mehmet Taşar
- Department of Pediatric Cardiovascular Surgery, Dr.Sami Ulus Maternity, Child Health and Disease Education and Research Hospital, Ankara, Turkey
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Rodríguez-Rubio P, Lacomba-Trejo L, Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M. 10Vida: A Mental and Physical Health Intervention for Chronically Ill Adolescents and Their Caregivers in the Hospital Setting: An Open Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063162. [PMID: 35328851 PMCID: PMC8953533 DOI: 10.3390/ijerph19063162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/04/2023]
Abstract
Suffering from a chronic disease (CD) in adolescence can significantly impact the emotional health of adolescents and their families. MHealth can be a useful tool for these groups. However, few intervention programmes include the family system. The aim is to design an intervention programme (10Vida) for a paediatric population with a CD, and their families, to improve their adaptation to the disease. The study is a quasi-experimental repeated measures design in a open study, where the patients themselves, and their families, are their own control group. Participants will receive an intervention of seven individual sessions: five sessions with each patient, and two sessions with their caregivers. In the case of the patients, the aim is to improve their emotional state, their self-esteem, and their emotional competencies, reducing their perceived threat of illness. Furthermore, in the case of the caregivers, the aim is to improve their emotional state and reduce their burden. Indirectly, working with caregivers and those being cared for will improve family ties. The pilot study will involve 25 to 30 chronically ill adolescents aged between 12 and 16 years and their primary caregivers. Following the results, the necessary modifications will be included, and the programme will be offered to adolescents and their families who are willing to participate.
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Affiliation(s)
- Pilar Rodríguez-Rubio
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain; (P.R.-R.); (L.L.-T.); (I.M.-C.)
| | - Laura Lacomba-Trejo
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain; (P.R.-R.); (L.L.-T.); (I.M.-C.)
| | - Selene Valero-Moreno
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain;
| | - Inmaculada Montoya-Castilla
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain; (P.R.-R.); (L.L.-T.); (I.M.-C.)
| | - Marián Pérez-Marín
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain; (P.R.-R.); (L.L.-T.); (I.M.-C.)
- Correspondence: ; Tel.: +34-963983392
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Jansson S, Malham M, Wewer V, Rask CU. Psychiatric comorbidity in childhood onset immune-mediated diseases-A systematic review and meta-analysis. Acta Paediatr 2022; 111:490-499. [PMID: 34986519 DOI: 10.1111/apa.16246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 12/01/2022]
Abstract
AIM To estimate psychiatric comorbidity in childhood onset immune-mediated inflammatory diseases (IMID). METHODS The PRISMA guidelines were followed, and the protocol was registered at Prospero (ID: CRD42021233890). Literature was searched in PubMed, PsycINFO and Embase. Original papers on prevalence rates of diagnosed psychiatric disorders and/or suicide in paediatric onset inflammatory bowel disease (pIBD), rheumatic diseases (RD) and autoimmune liver diseases were selected. Pooled prevalence rates of psychiatric disorders (grouped according to ICD-10 criteria) within the various IMID were calculated using random-effects meta-analysis. Risk of bias was evaluated by the Newcastle-Ottawa scale. RESULTS Twenty-three studies were included; 13 describing psychiatric disorders in pIBD and 10 in RD. Anxiety and mood disorders were mostly investigated with pooled prevalence rates in pIBD of 6% (95% confidence interval (CI): 4%-9%) and 4% (95%CI: 2%-8%), respectively, in register-based studies, and 33% (95%CI: 25%-41%) and 18% (95%CI: 12%-26%), respectively, in studies using psychiatric assessment. In RD, rates were 13% (95%CI: 12%-15%) for anxiety disorders and 20% (95%CI: 15%-26%) for mood disorders based on psychiatric assessment. CONCLUSION Anxiety and depression are commonly reported in childhood onset IMID. Physicians should be attentive to mental health problems in these patients as they seem overlooked.
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Affiliation(s)
- Sabine Jansson
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
- Department of Child and Adolescent Psychiatry Aarhus University Hospital Aarhus Denmark
| | - Mikkel Malham
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
- The Pediatric Department Holbaek Hospital Holbaek Denmark
| | - Vibeke Wewer
- The Pediatric Department Copenhagen University Hospital Hvidovre Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Hospital Aarhus Denmark
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Leonard SI, Turi ER, Powell JS, Usseglio J, Kolmodin MacDonell K, Bruzzese JM. Associations of asthma self-management and mental health in adolescents: A scoping review. Respir Med 2022; 200:106897. [PMID: 35714575 PMCID: PMC9871877 DOI: 10.1016/j.rmed.2022.106897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship. AIM This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships. METHODS Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date. RESULTS Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied. CONCLUSION Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.
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Affiliation(s)
- Sarah I. Leonard
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Eleanor R. Turi
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Jennifer S. Powell
- Division of Global and Community Health, Medical University of South Carolina
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center
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Turi ER, Reigada LC, Liu J, Leonard SI, Bruzzese JM. Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Ann Allergy Asthma Immunol 2021; 127:661-666.e1. [PMID: 34547441 PMCID: PMC8627490 DOI: 10.1016/j.anai.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.
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Affiliation(s)
- Eleanor R Turi
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Laura C Reigada
- Department of Psychology, Brooklyn College and The Graduate Center, The City University of New York, New York, New York
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Sarah I Leonard
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York.
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Mental Health in Pediatric Rheumatology: An Opportunity to Improve Outcomes. Rheum Dis Clin North Am 2021; 48:67-90. [PMID: 34798960 DOI: 10.1016/j.rdc.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mental health problems are more common in children with pediatric rheumatologic diseases (PRDs) than healthy peers. Mental health problems affect disease-related outcomes and health-related quality of life (HRQOL), so addressing these problems can improve clinical and psychosocial outcomes. Mental health screening tools are available, and there are resources available to aid in integrating mental health care into the clinical setting. By implementing these tools, mental health problems can be recognized and addressed.
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Ferro MA, Meyer SB, Yessis J, Reaume SV, Lipman E, Gorter JW. COVID-19-Related Psychological and Psychosocial Distress Among Parents and Youth With Physical Illness: A Longitudinal Study. Front Psychiatry 2021; 12:761968. [PMID: 34777063 PMCID: PMC8580883 DOI: 10.3389/fpsyt.2021.761968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023] Open
Abstract
Despite the initial thrust of research aimed at understanding the impact of the COVID-19 pandemic on youth with physical illness and their parents, knowledge gaps in the literature remain, providing the impetus for additional investigation. This study described changes in psychological distress from prior to during the COVID-19 pandemic for parents and youth with physical illness, compared parent-proxy and youth self-reported perceptions of COVID-19-related psychosocial health, and modeled factors associated with psychological and psychosocial distress. There were 147 parent-youth dyads (2-16 years) from MY LIFE-a longitudinal study of youth with physical illness. The Kessler-6 (K6) measured psychological distress for the time before the COVID-19 lockdown (December 19 to March 20) and during the pandemic (December 20 to March 21) among parents and youth. COVID-19-related psychosocial health was measured using the CRISIS. Parents and youth reported increases in K6 scores (d = 0.62 and 0.38). Parent-proxy reports on the K6 were lower vs. youth self-reports prior to and during the pandemic (d = 0.63 for both). In contrast, parents reported lower proxy CRISIS scores for worries (d = 0.38) and effects of social restrictions (d = 0.52). Pandemic parent K6 scores were associated with age, combined in-person and online schooling for youth, COVID-19-related worries, and effects of social restrictions. For youth, only COVID-19-related worries and effects of social restrictions were associated with K6 scores. Parent worries were associated with youth sex, parental stress, family functioning, online and combination learning, and social restrictions. Parental depression and worries were associated with effects of social restrictions. Youth worries were associated with online and combination learning, and social restrictions. Youth disability, online learning, and worries were associated with effects of social restrictions. Few clinical factors are associated with COVID-19-related psychological and psychosocial distress. Instead, parent/family factors and youth learning environment have prominent roles in predicting outcomes and have implications for the health, education, and social services systems.
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Affiliation(s)
- Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Yessis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shannon V. Reaume
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jan Willem Gorter
- Department of Pediatric Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, Netherlands
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Influence of Diagnostic Informing on Negative Emotions, Illness Perception, Self-Perceived Burden, and Posttraumatic Stress Disorder in Patients with Gastrointestinal Tumors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2568195. [PMID: 34691210 PMCID: PMC8528603 DOI: 10.1155/2021/2568195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
Objective To investigate the influence of diagnostic informing on negative emotions, illness perception (IP), self-perceived burden (SPB), and posttraumatic stress disorder (PTSD) in patients with gastrointestinal tumors. Methods A total of 261 patients with gastrointestinal tumors admitted to our hospital from January 2018 to December 2020 were selected. According to whether the patients were informed of the disease diagnosis, they were divided into the informing group (n = 125) and the concealment group (n = 136). The self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the brief illness perception questionnaire (BIPQ), the self-perceived burden scale (SPBS), and the PTSD checklist-civilian version (PCL-C) were used to investigate the two groups. Results The SAS and SDS scores of the informing group were lower than those of the concealment group (t = 7.853 and 6.444, P < 0.05). The total BIPQ score of the informing group was higher than that of the concealment group (t = -4.089, P < 0.05). The total SPBS score of the informing group was lower than that in the concealment group (t = 2.443, P < 0.05). The total PCL-C score of the informing group was lower than that of the concealment group (t = 2.173, P < 0.05). Conclusion Diagnosis informing can reduce the negative emotions, increase positive IP, and reduce the risk of SPB and PTSD in patients with gastrointestinal tumors.
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Hawke LD, Monga S, Korczak D, Hayes E, Relihan J, Darnay K, Cleverley K, Lunsky Y, Szatmari P, Henderson J. Impacts of the COVID-19 pandemic on youth mental health among youth with physical health challenges. Early Interv Psychiatry 2021; 15:1146-1153. [PMID: 33047495 PMCID: PMC7675347 DOI: 10.1111/eip.13052] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 09/26/2020] [Indexed: 12/28/2022]
Abstract
AIM To examine mental health in conjunction with physical health during the COVID-19 pandemic among youth with physical health conditions compared to those without. METHODS A cross-sectional survey of 622 youth aged 14 to 28 was conducted. Analyses were conducted to understand the changes in mental and physical health among youth in four groups: (a) participants with a friend or family member diagnosed with COVID-19, (b) participants with symptoms associated with COVID-19, (c) participants with atopic conditions (asthma and allergies), and (d) participants with other preexisting physical health conditions. RESULTS Many participants with physical health concerns met screening criteria for an internalizing disorder, which was significantly higher than the rate found among participants without physical health conditions. Significantly greater declines in self-reported mental health were observed during the COVID-19 period compared to 3 months earlier among youth reporting physical health concerns compared to those without physical health concerns. Substance use does not appear to have been affected. CONCLUSIONS Mental health concerns are highly prevalent among youth with physical health concerns, and also appear to be exacerbated by the COVID-19 pandemic. Physical health concerns appear to constitute risk factors for heightened mental health responses to the pandemic situation. System planners striving to adapt mental health services to meet social/physical distancing recommendations are urged to consider youth with physical health conditions and ensure that adequate integrated mental health and physical health supports are available to them.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Suneeta Monga
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Daphne Korczak
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Em Hayes
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | | | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
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Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY, Smith W, Major N, Church P, Cohen E, Orkin J. Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158205. [PMID: 34360497 PMCID: PMC8345967 DOI: 10.3390/ijerph18158205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.
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Affiliation(s)
- Arpita Parmar
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Kayla Esser
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Lesley Barreira
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Douglas Miller
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Leora Morinis
- Institute of Health, Policy, Management & Evaluation, Univeristy of California San Francisco, San Francisco, CA 94143, USA;
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Wanda Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Nathalie Major
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Paige Church
- Divison of Neonatology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Institute of Health, Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
| | - Julia Orkin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
- Correspondence: ; Tel.: +416-813-7654
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Prentice K, Rees C, Finlay-Jones A. Self-Compassion, Wellbeing, and Distress in Adolescents and Young Adults with Chronic Medical Conditions: the Mediating Role of Emotion Regulation Difficulties. Mindfulness (N Y) 2021; 12:2241-2252. [PMID: 34335989 PMCID: PMC8311066 DOI: 10.1007/s12671-021-01685-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Objectives Adolescents and young adults with chronic medical conditions report higher distress and lower wellbeing than their physically healthy peers. Previous research suggests that self-compassion is negatively correlated with distress and positively correlated with wellbeing among healthy young people, as well as adults with chronic medical conditions. The current study aimed to extend these findings to a sample of adolescents and young adults with chronic medical conditions. This study also aimed to replicate findings observed in other populations by testing emotion regulation difficulties as a mediator of this relationship. Methods Adolescents and young adults aged 16 to 25 with chronic physical medical conditions (N = 107) completed an online survey including measures of self-compassion, emotion-regulation, wellbeing, and distress. Two mediation models were tested using the PROCESS macro in SPSS, with distress and wellbeing as outcomes. Results Self-compassion had a significant direct negative association with distress and a significant direct positive association with wellbeing. While self-compassion and emotion regulation difficulties explained a large amount of variance in both wellbeing, R2 = .31, p < .001, and distress, R2 = .46, p < .001, no support was found for the mediating role of emotion regulation difficulties between self-compassion and wellbeing. However, emotion regulation difficulties mediated the relationship between self-compassion and distress. Conclusions These findings suggest that an emotion regulation model of self-compassion may be applicable to young people with chronic medical conditions. Future research within this population may evaluate programs that develop self-compassion and emotion regulation skills.
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Affiliation(s)
- Karina Prentice
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Western Australia Australia
| | - Clare Rees
- Curtin University, Kent St, Bentley, Perth, Western Australia Australia
| | - Amy Finlay-Jones
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Western Australia Australia
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