A help-line for children. Seasonal variations in issues

School Anxiety in Children and Adolescents with Chronic Pain

Anxiety is highly prevalent in pediatric chronic pain. This comorbidity has been explained by the presence of shared mechanisms underlying the development and maintenance of chronic pain and anxiety. Accumulating evidence demonstrates that school is a significant source of anxiety among youth with chronic pain and that anxiety contributes to school-related functional impairment in this population. This article reviews the cooccurrence of pediatric chronic pain and anxiety, identifies unique sources of heightened school anxiety among youth with chronic pain, and describes current approaches for assessing anxiety in pediatric pain settings. Highlighted by this review is the absence of a comprehensive evidence-based approach for assessing school anxiety in pediatric chronic pain. Given the psychometric limitations inherent to gathering data from a single source, recommendations for advancing measurement methods are provided. Novel approaches may be needed to shed more light on the way in which school anxiety is experienced in pediatric chronic pain.

The influence of unemployment and divorce rate on child help-seeking behavior about violence, relationships, and other issues

OBJECTIVE

This study examined the influence of community unemployment and divorce rate on child help-seeking behavior about violence and relationships via a telephone and Internet helpline.

METHODS

Time series analysis was conducted on monthly call volumes to a child helpline ('De Kindertelefoon') in the Netherlands from 2003 to 2008 and on the topics discussed (primarily Violence and Relationships) from 1994 to 2008 in answered calls and chats.

RESULTS

As unemployment rises, the number of calls to the helpline increases. With increased unemployment, the share of conversations about violence and about relationships is found to be higher. When the divorce rate goes up, the number of calls to the helpline increases, but the share of Violence and of Relationships decreases. In addition, the share of contacts about Violence is increasing over time, while the share about Relationships is decreasing. Furthermore, the showing of violent movies is associated with fewer attempted helpline calls. Finally, seasonal variation in call volumes and the shares of calls about Violence and Relationships are found.

CONCLUSION

Our data provide a unique and direct perspective on child help-seeking behavior. Our results suggest that more resources need to be devoted to resolving children's problems during times of unemployment as they seek more help particularly with respect to violence. Increased training of counselors with regard to children reporting incidents of violence is particularly important, as the share of contacts about violence is increasing over time and during a recession. Resources are especially needed as, on average, less than half of the calls to child helplines are actually answered.

Adolescent help-seeking and the Yellow Ribbon Suicide Prevention Program: an evaluation

The Yellow Ribbon Suicide Prevention Program has gained national and international recognition for its school- and community-based activities. After the introduction of Yellow Ribbon to a Denver-area high school, staff and adolescents were surveyed to determine if help-seeking behavior had increased. Using a pre-post intervention design, staff at an experimental school and comparison school were surveyed about their experiences with student help-seeking. Additionally, 146 students at the experimental high school were surveyed. Staff did not report any increase in student help-seeking, and students' reports of help-seeking from 11 of 12 different types of helpers did not increase; the exception was help-seeking from a crisis hotline, which increased from 2.1% to 6.9%. Further research with larger, more inclusive samples is needed to determine whether Yellow Ribbon is effective in other locations.

Seasonal variation in the presentation of abdominal pain

BACKGROUND

Anxiety and depression, conditions frequently associated with childhood chronic abdominal pain (AP), are characterized by seasonal exacerbations. A seasonal pattern characterized by a higher frequency of consultations for AP during winter has been suspected but has never, to our knowledge, been demonstrated. We hypothesize the presence of a seasonal variation in AP consultations with a winter predominance.

AIMS

To determine the seasonal distribution of AP consultations among centers across time and geographic latitude.

PATIENTS AND METHODS

This was a retrospective cohort study. The number of outpatient consultations from primary care clinics and every pediatric specialty clinic that resulted in a diagnosis of AP and the total number of outpatient consultations (2001-2004) from 6 tertiary care institutions (Chicago, Pittsburgh, Wilmington, Pensacola, Orlando, Jacksonville) was determined. Rates of consultations were compared across time and between cities. Four time periods of interest, with 2- and 3-month definitions, were arbitrarily selected. Seasonal rates across time were compared separately for each of the 2-month (January-February vs June-July) and 3-month periods (January-March vs June-August). Logistic regression models for each city were used to determine variations in the rate of outpatient AP cases by season or by year.

RESULTS

A total of 3,929,522 outpatient consultations and 73,591 AP consultations were analyzed. The rates of AP consultations were consistently higher in the winter months at all of the sites. The results differed between sites at northern and southern latitudes.

CONCLUSIONS

There seems to be a seasonal variation in consultation patterns for AP at the tertiary care level. A possible role of daylight hours, climate, latitude, and stress is proposed.

Pacientes psiquiátricos en el servicio de urgencias de pediatría de un hospital terciario: revisión de un período de 6 meses

INTRODUCTION

In the last few years, a marked increase in the number of psychiatric emergencies treated at pediatric emergency departments has been observed. The aim of the present study was to characterize these patients.

PATIENTS AND METHODS

We performed a descriptive, prospective, cross sectional study, based on all psychiatric emergencies treated at the pediatric emergency department of Hospital General Universitario Gregorio Marañón, Madrid, from 1-10-04 to 31-3-05. The following variables were analyzed: age, sex, time of consultation, day of the week, day of the month, month of the year, psychiatric antecedents, previous psychiatric pharmacologic treatment, the person or service who took the child to hospital, diagnosis, and whether the patient was admitted to the hospital.

RESULTS

Of a total of 36,449 emergencies, 79 were psychiatric (0.21 %). Sex rates were 48.1 % boys and 51.9 % girls. The mean (+/-2 SD) age was 13.73 +/- 2.5 years. Visits were most frequent on Mondays (19 %), in the evening, and in January and February. A total of 13.23 % of the patients were brought by extrahospital services. The main diagnoses were: behavioral disorders (36.76 %), anxiety disorders (20.58 %) and suicidal ideation or suicide attempt (13.23 %). There was a clear male predominance in behavioral disorders (67.85 %) and a female predominance in anxiety disorders (71.42 %) and suicidal ideation or suicide attempt (76.92 %). The hospitalization rate among these patients was 32.35 %.

CONCLUSIONS

The incidence of psychiatric disorders in our pediatric emergency department was low. The patients were aged 11-15 years old, without differences between the sexes. Peak demand was reached on Mondays in January and February, at the end of the evening and beginning of the night. The most common diagnosis was behavioral disorder. The hospitalization rate was exceptionally high, more than 6 times higher than the average in our hospital.