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Davis RS, Devaney J, Halligan SL, Meiser-Stedman R, Oliveira P, Smith P, Stallard P, Kandiyali R, Phillips A, John A, Hiller RM. The feasibility and acceptability of delivering a group trauma-focused intervention to children in care. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39054608 DOI: 10.1111/bjc.12494] [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: 11/06/2023] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Young people in care (i.e., in the child welfare system) are a group who have often experienced very high rates of potentially traumatic events, including maltreatment. It is well-documented that they have high rates of trauma-related mental health difficulties, such as posttraumatic stress. To address the needs of the large number of young people who may benefit from support, scalable interventions are crucial. But also important is that they are effective and deliverable - particularly given the complexity of this group and services. We assessed a five-session group CBT-based intervention for PTSD. The primary goal was to understand core procedural and protocol uncertainties to address prior to a definitive trial. METHODS Participants were 34 10-17 year olds in care, with moderate to severe posttraumatic stress symptoms, and their caregiver. We ran seven groups (four online), delivered in social care and NHS-based mental health teams. Data were collected via pre-, post-, 3-month follow-up questionnaires and qualitative interviews. RESULTS Of the 34 participants allocated to the intervention, 27 (80%) attended at least three of the five sessions (most attended all). Caregiver attendance was lower (50%). There was generally good completion of assessment measures. Qualitatively, most participants were positive about the intervention, and many reported improvements in areas such as coping, sleep, and willingness to talk about experiences. However, there were important concerns about the lack of ongoing support, given this was a low-intensity intervention for a group who often had complex needs. CONCLUSION The intervention and research protocols were acceptable to most young people and carers. With modifications, a future definitive trial would likely be possible. However, key considerations include: how (and whether) to screen for PTSD; the trial design; and the option to embed high-intensity support (e.g., via assessing a stepped-care model).
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Affiliation(s)
| | - John Devaney
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Paula Oliveira
- Anna Freud National Centre for Children and Families, London, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | - Aalia John
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel M Hiller
- Department of Psychology, University of Bath, Bath, UK
- Anna Freud National Centre for Children and Families, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
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McGuire R, Meiser-Stedman R, Smith P, Schmidt D, Bjornstad G, Bosworth R, Clarke T, Coombes J, Geijer Simpson E, Hudson K, Oliveira P, Macleod J, McGovern R, Stallard P, Wood K, Hiller RM. Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39012021 DOI: 10.1111/bjc.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/15/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Rates of PTSD are up to 12 times higher in care-experienced young people (CEYP) compared to their peers. Trauma-focused CBTs (tf-CBT) are the best-evidenced treatment for youth with PTSD, yet, in practice, CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf-CBT) to CEYP. DESIGN This was an active, open implementation trial. METHODS We recruited 28 mental health teams across England, including general CAMHS, targeted CAMHS for CEYP and social care-based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling three monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using CFIR 2.0. RESULTS Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams particularly highlighted service structures and poor resourcing as major barriers to delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included commissioning practices, the culture of the team, leadership engagement and style, and the development of supervision structures. CONCLUSIONS Findings offer key considerations for mental health teams, service leads, commissioners and policy-makers to enhance delivery of best-evidenced mental health treatments like CT-PTSD, for CEYP.
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Affiliation(s)
- Rosie McGuire
- Division of Psychology & Language Sciences, UCL, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Davin Schmidt
- Division of Psychology & Language Sciences, UCL, London, UK
| | | | | | | | - Joe Coombes
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emma Geijer Simpson
- Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Kristian Hudson
- Improvement Academy, NIHR ARC Yorkshire & Humber, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Paula Oliveira
- Anna Freud National Centre for Children & Families, London, UK
| | - John Macleod
- NIHR School for Primary Care, University of Bristol, Bristol, UK
| | - Ruth McGovern
- Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | | | - Katie Wood
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rachel M Hiller
- Division of Psychology & Language Sciences, UCL, London, UK
- Anna Freud National Centre for Children & Families, London, UK
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Armoon B, Ghadipasha A, Mohammadi R, Lesage A, Harooni J, Griffiths MD. The global prevalence of mental health disorders among runaway and homeless youth: A meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02519-2. [PMID: 38995408 DOI: 10.1007/s00787-024-02519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
A meta-analysis was performed to identify the pooled prevalence of mental health disorders (MHDs) among runaway and homeless youth (RHY). Relevant studies published between December 1, 1985, and October 1, 2023, were identified in the PubMed, Scopus, Web of Science, and Cochrane Library databases. A preliminary screening of 11,266 papers resulted in the inclusion of 101 studies. The pooled-prevalence estimates were obtained using a random-effects model. The findings showed varying lifetime prevalence rates of MHDs: 47% (conduct disorders and psychological distress), 43% (depression), 34% (major depressive disorders), 33% (post-traumatic stress disorder), 27% (personality disorders), 25% (attention-deficit/hyperactivity disorder), 23% (bipolar disorders), 22% (anxiety), 21% (oppositional defiant disorders), 15% (anorexia), 15% (adjustment disorders), 14% (dysthymia), 11% (schizophrenia), 9% (obsessive-compulsive disorders), and 8% (gambling disorder). The current prevalence rates were: 31% (depression), 23% (major depressive disorder), 23% (anxiety), 21% (post-traumatic stress disorder), 16% (attention-deficit/hyperactivity disorder), 15% (bipolar disorder), 13% (personality disorders), 13% (oppositional defiant disorders), 8% (schizophrenia), and 6% (obsessive-compulsive disorders). Regular screening and the implementation of evidence-based treatments and the promotion of integration and coordination between mental health services for adolescent minors and young adults with other service systems are recommended.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amir Ghadipasha
- Firoozabadi Hospital, Iran University of Medical Science, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alain Lesage
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Javad Harooni
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
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Ball WP, Anderson C, Black C, Gordon S, Lackenby M, Murchie M, Ostrovska B, O'Sullivan K, Rowlands H, Rzewuska Díaz M, Butler JE. Mental health service use in children at risk of significant harm: A record linkage study of a child protection register. Soc Sci Med 2024; 353:117057. [PMID: 38905923 DOI: 10.1016/j.socscimed.2024.117057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify children at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce risk. Prevalence and incidence of mental health service use among this population of children are not well understood. We analysed records from one Scottish Local Authority's CPR, linked to electronic health records for all children in the broader health board region aged 0-17 years. We described mental health service use among children with a CPR registration using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We calculated age- and sex-specific incidence rates for comparison with the general population. Between 2012 and 2022, we found 1498 children with a CPR registration, with 69% successfully linked to their health records. 20% were registered before birth and median age at registration was 3 years. Incidence rates in all measures of mental health service use were higher in children with a CPR record across all ages (at outcome) and genders compared to the general population. The largest absolute difference was for boys aged 5-9 with a CPR record, who had 31.8 additional mental health prescriptions per 1000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1000 person-years, IRR: 2.7). Girls aged 0-4 years with a CPR registration had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 per 1000 person-years). Our reproducible record linkage of the CPR to health records reveals an increased risk of mental health service use during childhood. Our findings have relevance to public mental health surveillance, service prioritisation and wider policy aiming to reduce childhood exposure to risk of harm.
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Affiliation(s)
| | | | - Corri Black
- University of Aberdeen, Aberdeen, Scotland, UK; NHS Grampian, Aberdeen, Scotland, UK
| | | | | | | | - Bārbala Ostrovska
- Aberdeen Centre for Health Data Science PPIE Group, Aberdeen, Scotland, UK
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Balogun-Katung A, Artis B, Alderson H, Brown E, Kaner E, Rankin J, Lingam R, McGovern R. Practitioner perspectives on the nature, causes and the impact of poor mental health and emotional wellbeing on children and young people in contact with children's social care: A qualitative study. CHILD ABUSE & NEGLECT 2024; 154:106867. [PMID: 38852432 DOI: 10.1016/j.chiabu.2024.106867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/09/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Children and young people (CYP) who are in contact with social care are at higher risk of developing mental health difficulties compared to the general population. This has been attributed to their experience of significant childhood adversity. With an increased likelihood of experiencing poorer health outcomes which can persist into adulthood, it is crucial that key factors for their positive mental health development are identified. OBJECTIVE To identify factors associated with the poor mental health of CYP in contact with social care from the perspective of practitioners working in children's social care and mental health. PARTICIPANTS AND SETTING Social care and mental health practitioners; three Local Authorities across the North-East of England. METHODS Four focus groups were conducted with 23 practitioners between April and May 2022. A semi-structured topic guide exploring the nature and associated factors of mental health was used to focus discussion. Data were thematically analysed and informed by the four levels of the socio-ecological model. RESULTS Individual level risk factors were associated with the CYP's emotional health and included what practitioners described as the 'sense of shame'. Interpersonal level risk factors were most recurrent and included parental factors within the home environment. Community level risk factors consisted of characteristics of settings and institutions that increased the risk of the CYP developing mental health and wellbeing difficulties. Societal level risk factors included broader societal factors such as poverty. Practitioners maintained that certain protective factors possessed or developed by CYP including secure attachments, prevent the development of mental health difficulties. CONCLUSIONS Our current study provides strong evidence for the interlinkage between multiple levels of risk and their interacting impact on the CYP's mental health and emotional wellbeing. It is imperative that this, and the need to strengthen protective factors, whilst reducing risks are carefully considered for the development of effective support interventions for CYP in contact with social care.
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Affiliation(s)
- A Balogun-Katung
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland.
| | - B Artis
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
| | - H Alderson
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
| | - E Brown
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
| | - J Rankin
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
| | - R Lingam
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland; Population Child Health Research Group, UNSW, Australia
| | - R McGovern
- Population Health Sciences Institute, Newcastle University, United Kingdom of Great Britain and Northern Ireland
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Latifian M, Aarabi MA, Esmaeili S, Abdi K, Raheb G. The role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran. BMC Psychiatry 2024; 24:420. [PMID: 38834960 DOI: 10.1186/s12888-024-05853-6] [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: 11/14/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The World Health Organization defines mental health as a combination of two dimensions: the negative dimension, or negative mental health, which indicates the presence of mental disorders, symptoms, and problems, and the positive dimension, or positive mental health, which includes emotions and positive personal characteristics such as self-esteem, resilience against environmental challenges, a sense of integrity, and self-efficacy. The aim of the present study was to investigate the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran, Iran. METHOD The research method employed was a survey. 758 people participated in the study, and the samples consisted of high school students in Tehran during the academic year 2022-2023. The process of collecting information was carried out by distributing the questionnaire link through virtual networks and schools. The research utilized Young's Internet Addiction Test, Samuels' Academic Resilience Inventory, and Goldberg's Mental Health Questionnaire as the research tools. Statistical tests, including Pearson's correlation and multiple regression analysis, were employed to investigate the relationships between variables. RESULT The effect of internet addiction on mental health (ß=0.39) is negative and significant at the 0.001 level, while the effect of academic resilience on mental health (ß=0.66) is positive and significant at the 0.001 level. These two variables collectively predict 53% of the variance in students' mental health. This indicates that as internet addiction increases among students, their mental health significantly decreases, whereas higher levels of academic resilience correspond to higher mental health. CONCLUSIONS This study has elucidated the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran. Given the significance of adolescent mental health, it is imperative for healthcare professionals and other stakeholders to develop intervention and prevention models to address mental health crises and plan for the enhancement of adolescent mental health.
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Affiliation(s)
- Maryam Latifian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mahta Alsadat Aarabi
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sahar Esmaeili
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ghoncheh Raheb
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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7
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Emmerich OLM, Wagner B, Heinrichs N, van Noort BM. Lifetime victimization experiences, depressiveness, suicidality, and feelings of loneliness in youth in care. CHILD ABUSE & NEGLECT 2024; 154:106870. [PMID: 38823332 DOI: 10.1016/j.chiabu.2024.106870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples. OBJECTIVE The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC. PARTICIPANTS AND SETTING 164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care. METHODS The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated. RESULTS Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (β = 0.23, p = .002) and loneliness (β = 0.22, p = .006), sexual victimization with depressiveness (β = 0.22, p = .004). CONCLUSION Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization.
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Affiliation(s)
| | - Birgit Wagner
- Medical School Berlin, Rüdesheimer Straße 50, 14197 Berlin, Germany.
| | - Nina Heinrichs
- Universität Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany.
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Kersten L, Alfano J, Erlanger TE, Helfenstein F, Lanz L, Weiss S, Chilla C, von Planta B, Kapoor M, Borel N, Rocco T, Papageorgiou A, De Brito CF, Bajrami A, Savary V, Mayor M, Hurschler J, Traut A, Brunner D, Vriends N, Stadler C. START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial. Trials 2024; 25:341. [PMID: 38778383 PMCID: PMC11112814 DOI: 10.1186/s13063-024-08180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.
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Affiliation(s)
- Linda Kersten
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Janine Alfano
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tobias E Erlanger
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Lelia Lanz
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Stefan Weiss
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Chiara Chilla
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Beryll von Planta
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Madlaina Kapoor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Nathalie Borel
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Tabea Rocco
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Andreas Papageorgiou
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Catarina Fernandes De Brito
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Arzie Bajrami
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Valentine Savary
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Melanie Mayor
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jana Hurschler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Alex Traut
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Donja Brunner
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Noortje Vriends
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Christina Stadler
- Department of Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
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Mkhize M, van der Westhuizen C, Sorsdahl K. Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa. Compr Psychiatry 2024; 131:152469. [PMID: 38461564 DOI: 10.1016/j.comppsych.2024.152469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 03/02/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Between 10 and 20% of children and adolescents globally experience common mental health conditions such as depression or anxiety. Given the dearth of mental health services in low- and middle-income countries, most mental health conditions among adolescents remain undiagnosed and untreated. In South Africa, few studies have explored the prevalence of depression and anxiety among young adolescents aged 10-14 years. This study examined the prevalence of, and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa. METHODS A cross-sectional study was conducted in 10 schools in the Western Cape Province from February to July 2022. Data were collected using a tablet-based survey and included sociodemographic items, the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire for Adolescents (PHQ-A) and other psychosocial measures. The prevalence of depression and anxiety was estimated based on cut-off scores for the GAD-7 and PHQ-A. Multivariable logistic regression models were used to investigate the associations between sociodemographic and psychosocial factors, and depression and anxiety. RESULTS Of the 621 adolescents, 33.5% (n = 208) reported experiencing symptoms of depression and 20.9% (n = 130) symptoms of anxiety potentially indicative of a diagnosis. The results of the multivariable logistic regression model indicate that being in a higher grade in school (AOR = 1.65, CI:1.43-1.92), any lifetime alcohol use (AOR = 1.62, CI:1.04-2.64), other drug use (AOR = 2.07, CI:1.06-4.04), and witnessing violence among adults at home (AOR = 2.12, CI:1.07-1.41) were significantly associated with experiencing depressive symptoms. Being in a higher grade in school (AOR = 1.69, CI: 1.42-2.01), poor emotional regulation skills (AOR = 1.03, CI: 1.00-1.07), and the use of cannabis (AOR = 1.03, CI: 1.00-1.07) were significantly associated with experiencing anxiety symptoms. CONCLUSION These findings add to our understanding of school-going adolescents' pressing mental health needs and suggest that mental health adolescent and caregiver interventions may be required to address mental health symptoms and associated risk factors.
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Affiliation(s)
- Mirriam Mkhize
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Claire van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Guimarães RM, Moreira MR, Costa NDR. Demographic dynamics and the emergency of health policies' review for the child and youth population in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100700. [PMID: 38404623 PMCID: PMC10884745 DOI: 10.1016/j.lana.2024.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
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Phillips AR, Hiller RM, Halligan SL, Lavi I, Macleod JAA, Wilkins D. A qualitative investigation into care-leavers' experiences of accessing mental health support. Psychol Psychother 2024. [PMID: 38456637 DOI: 10.1111/papt.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services. METHODS We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up. RESULTS Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met. CONCLUSIONS We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.
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Affiliation(s)
| | - Rachel M Hiller
- Division of Psychology & Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | | | - Iris Lavi
- Department of Psychology, University of Bath, Bath, UK
| | - John A A Macleod
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Academic Primary Care, Bristol Medical School, The University of Bristol, Bristol, UK
| | - David Wilkins
- Children's Social Care Research and Development Centre, School of Social Sciences, Cardiff University, Cardiff, UK
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Penttilä S, Niemelä M, Hakko H, Keski-Säntti M, Ristikari T, Räsänen S. Child- and parent-related determinants for out-of-home care in a nationwide population with neurodevelopmental disorders: a register-based Finnish birth cohort 1997 study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02406-w. [PMID: 38430236 DOI: 10.1007/s00787-024-02406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
Neurodevelopmental disorders (NDDs) are among the most common health issues in childhood and adolescence. Psychiatric disorders are known to be overrepresented among children using child welfare services and placed in out-of-home care (OHC). Child- and parent-related determinants for OHC among a national population with NDDs were evaluated utilising longitudinal register data from the national Finnish Birth Cohort 1997 (n = 58,802) from birth to 18 years (1997-2015). The cohort members with NDDs (n = 5,143, 9% of total cohort) formed our study population. Based on their history of OHC, cohort members with NDD were categorised to OHC (n = 903) and non-OHC groups (n = 4,240). Of all cohort members with NDDs, 17.6% had a history of OHC. Within NDDs, a significant excess of ADHD diagnosis was observed in the OHC group compared to the non-OHC group (49% vs. 26%). The OHC group with NDDs was significantly characterised by having comorbid psychiatric diagnosis for conduct and oppositional disorders (adj. RR 2.21), substance use disorders (adj. RR 1.61) and depression and anxiety disorders (adj. RR 1.60). Of all parent-related determinants, the most prevailing in the OHC group compared to the non-OHC group, was social assistance received by parent (88% vs. 44.5%). The longer the period (in years) for received social assistance, the greater the likelihood for OHC (adj. RRs range from 2.41 for one year to 5.24 for over 4 years). Further, significantly associating determinants for OHC were parental psychiatric disorders (adj. RR 1.42) and parental death (adj. RR 1.23). Our findings from the population-based cohort of children and adolescents with NDDs highlight the importance of screening and assessment of family situation. Also, effective prevention and treating of comorbid psychiatric disorders, especially conduct and oppositional disorders is essential.
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Affiliation(s)
- Sanni Penttilä
- Faculty of Medicine, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
| | - Mika Niemelä
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Helinä Hakko
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | | | - Sami Räsänen
- Faculty of Medicine, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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13
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Stadler C, Freitag CM, Popma A, Nauta-Jansen L, Konrad K, Unternaehrer E, Ackermann K, Bernhard A, Martinelli A, Oldenhof H, Gundlach M, Kohls G, Prätzlich M, Kieser M, Limprecht R, Raschle NM, Vriends N, Trestman RL, Kirchner M, Kersten L. START NOW: a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder - a randomized clinical trial. J Child Psychol Psychiatry 2024; 65:316-327. [PMID: 37814906 DOI: 10.1111/jcpp.13896] [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] [Accepted: 07/12/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Conduct disorder (CD) and oppositional defiant disorder (ODD) both convey a high risk for maladjustment later in life and are understudied in girls. Here, we aimed at confirming the efficacy of START NOW, a cognitive-behavioral, dialectical behavior therapy-oriented skills training program aiming to enhance emotion regulation skills, interpersonal and psychosocial adjustment, adapted for female adolescents with CD or ODD. METHODS A total of 127 girls were included in this prospective, cluster randomized, multi-center, parallel group, quasi-randomized, controlled phase III trial, which tested the efficacy of START NOW (n = 72) compared with standard care (treatment as usual, TAU, n = 55). All female adolescents had a clinical diagnosis of CD or ODD, were 15.6 (±1.5) years on average (range: 12-20 years), and were institutionalized in youth welfare institutions. The two primary endpoints were the change in number of CD/ODD symptoms between (1) baseline (T1) and post-treatment (T3), and (2) between T1 and 12-week follow-up (T4). RESULTS Both treatment groups showed reduced CD/ODD symptoms at T3 compared with T1 (95% CI: START NOW = -4.87, -2.49; TAU = -4.94, -2.30). There was no significant mean difference in CD/ODD symptom reduction from T1 to T3 between START NOW and TAU (-0.056; 95% CI = -1.860, 1.749; Hedge's g = -0.011). However, the START NOW group showed greater mean symptom reduction from T1 to T4 (-2.326; 95% CI = -4.274, -0.378; Hedge's g = -0.563). Additionally, secondary endpoint results revealed a reduction in staff reported aggression and parent-reported irritability at post assessment. CONCLUSIONS Although START NOW did not result in greater symptom reduction from baseline to post-treatment compared with TAU, the START NOW group showed greater symptom reduction from baseline to follow-up with a medium effect size, which indicates a clinically meaningful delayed treatment effect.
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Affiliation(s)
- Christina Stadler
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Arne Popma
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lucres Nauta-Jansen
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen & Research Centre Juelich, Juelich, Germany
| | - Eva Unternaehrer
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Katharina Ackermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anne Martinelli
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Malou Gundlach
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Gregor Kohls
- Department of Child and Adolescent Psychiatry, Medical Faculty, TU Dresden, Dresden, Germany
| | - Martin Prätzlich
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Meinhard Kieser
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Ronald Limprecht
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Nora M Raschle
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | | | | | - Marietta Kirchner
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Linda Kersten
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
- Department of Forensic Psychiatry, LVR-Klinik Viersen, Viersen, Germany
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Trubey R, Evans R, McDonald S, Noyes J, Robling M, Willis S, Boffey M, Wooders C, Vinnicombe S, Melendez-Torres GJ. Effectiveness of Mental Health and Wellbeing Interventions for Children and Young People in Foster, Kinship, and Residential Care: Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024:15248380241227987. [PMID: 38362816 DOI: 10.1177/15248380241227987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The mental health and wellbeing of children and young people who have been in care, primarily foster care, kinship care or residential care, remains a public health priority. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) synthesized evidence for the effectiveness of interventions targeting: subjective wellbeing; mental, behavioral and neurodevelopmental disorders; and suicide-related outcomes. Searches were conducted in 16 bibliographic databases and 22 websites between 1990 and 2022. This was supplemented by citation tracking, screening of relevant systematic reviews, and expert recommendation. We identified 35 interventions, with 44 evaluations via randomized controlled trials. Through meta-analyses, we found that interventions have a small beneficial impact on a variety of mental health outcomes in the short term (0-6 months). Interventions improved total social, emotional, and behavioral problems (d = -0.15, 95% CI [-0.28, -0.02]), social-emotional functioning difficulties (d = -0.18, 95% CI [-0.31, -0.05]), externalizing problem behaviors (d = -0.30, 95% CI [-0.53, -0.08]), internalizing problem behaviors (d = -0.35, 95% CI [-0.61, -0.08]); and depression and anxiety (d = -0.26, 95% CI [-0.40, -0.13]). Interventions did not demonstrate any effectiveness for outcomes assessed in the longer term (>6 months). Certainty of effectiveness was limited by risk of bias and imprecision. There was limited available evidence for interventions targeting subjective wellbeing and suicide-related outcomes. Future intervention design and delivery must ensure that programs are sufficient to activate causal mechanisms and facilitate change. Evaluation research should use a robust methodology.PROSPERO Registration: CRD42020177478.
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Mitiku KW, Tegegne E, Amsalu M, Habtegiorgis SD, Melaku B. Mental illness in children and its determinants in Ethiopia: A systematic review and meta-analysis, 2023. Clin Child Psychol Psychiatry 2024; 29:168-186. [PMID: 37864448 DOI: 10.1177/13591045231209078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Young people are at risk of developing mental health disorders. Depression, anxiety, and behavioral problems are among the primary causes of illness and impairment among teenagers. Suicide is the fourth highest cause of mortality in those aged 15 to 29. This study aimed to assess the determinants of mental health among children in Ethiopia. METHODS Online databases were searched from inception until March 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 was used in this review. Subgroup analysis, I2 test, funnel plot, and Egger's test were performed. Pooled odds ratios (OR) were calculated. RESULT Fourteen studies were included in the meta-analysis. The pooled prevalence of mental illnesses among Ethiopian children was 24.68% (95% CI: 19.99%-32.38%). Having previous child abuse history (OR: 5.65; 95% CI: 4.32-7.39), poor socio-economic status (OR: 1.94; 95% CI: 1.24-3.04), urban residence (OR: 1.93; 95% CI:1.39-2.67), and being male (OR: 1.65; 95% CI: 1.15-2.38) were determinants of childhood mental illness in Ethiopia. CONCLUSION and Recommendations: Mental disorders are highly prevalent in children with a history of child abuse, and a strong legislative body must be established to prosecute child abusers. Interventions that focus on gender equality in education and the creation of a safe environment for poor urban children are suggested.
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Affiliation(s)
- Kalkidan Worku Mitiku
- Department of Public Health, College of health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental health, College of health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Menichil Amsalu
- Department of Public Health, College of health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Samuel Derbie Habtegiorgis
- Department of Public Health, College of health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Birhanu Melaku
- School of Medicine and Health Science, Department of Public Health, GAMBY Medical and Business College, Bahirdar, Ethiopia
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Kaferly J, Orsi-Hunt R, Hosokawa P, Sevick C, Creel LM, Mathieu S, Mark Gritz R. Health Differs by Foster Care Eligibility: A Nine-Year Retrospective Observational Study Among Medicaid-Enrolled Children. Acad Pediatr 2023:S1876-2859(23)00471-0. [PMID: 38142889 DOI: 10.1016/j.acap.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE This study sought to determine the prevalence and rates of physical, behavioral, and chronic health conditions among Medicaid-enrolled Colorado children by foster care eligibility codes over 9 years. METHODS This retrospective, population-based study used Colorado's Medicaid administrative data for all enrolled children, aged <19 years old, from July 2011 to August 2020 to determine the period prevalence and rates of physical, behavioral, and chronic health conditions. We identified children in foster care by Medicaid eligibility codes and used the Pediatric Medical Complexity Algorithm version 3.0 to describe health condition outcomes. We report frequencies and percentages by foster care eligibility status, birth year cohort, and sex. RESULTS Among 1,084,026 children, we identified 34,971 children in the foster cohort. Rates of physical (1105.0 per 100,000 person-months (PMs)) and behavioral health conditions (583.6 per 100,000 PMs) were two to threefold higher among the foster cohort than peers (physical 685.1 per 100,000 PMs; behavioral 212.2 per 100,000 PMs). By birth cohort, rates of behavioral health conditions among children in foster care were up to 8 times greater than peers. The foster cohort had greater prevalence of chronic conditions with (55.2%) and without (38.6%) behavioral health inclusion. CONCLUSIONS This study provides a broader health assessment among Medicaid-enrolled children and finds condition disparities concentrated among youth in foster care. A more complete understanding of health problems among children in foster care is critical for health, child welfare, and Medicaid systems to improve health outcomes through coordinated and evidence-based interventions, programs, and policies.
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Affiliation(s)
- James Kaferly
- Department of Ambulatory Care Services, Denver Health and Hospital Authority, Denver, Colo; The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, Colo; Eugene Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, Colo.
| | - Rebecca Orsi-Hunt
- The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, Colo.
| | - Patrick Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colo.
| | - Carter Sevick
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colo.
| | - Liza Michelle Creel
- Eugene Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, Colo.
| | - Susan Mathieu
- Eugene Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, Colo.
| | - Robert Mark Gritz
- Eugene Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, Colo.
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McTavish JR, MacMillan HL. The need for meaningful support following exposure to sexual assault. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1799-1801. [PMID: 35128577 DOI: 10.1007/s00127-022-02232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Jill R McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Caci H. Prevalence rate of ADHD in France: Review of the literature and results from ChiP-ARD study. L'ENCEPHALE 2023; 49:624-631. [PMID: 37612161 DOI: 10.1016/j.encep.2023.05.006] [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: 01/31/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder whose first clinical description was published more than two centuries ago. Prevalence rates have been evaluated in many countries and meta-analyses conducted, but the data collected in France are scarce. METHODS A review of the literature was conducted by retrieving the references from four electronic databases leading to the selection of four studies in children and four in adults. Meta-analyses of prevalence rates were performed on this published data as well as unpublished results from the ChiP-ARD study (Children and Parents with ADHD and Related Disorders), separately for children and adults. RESULTS While the quality of most studies is questionable, the prevalence rates are close to those reported in international meta-analytic studies for children (3.68%), but are higher in adults (5.5%). CONCLUSIONS Well-conducted studies in both general and special populations are needed (e.g., in patients with depression, anxiety, bipolar disorder, developmental disorders including autism spectrum disorder, behavioural or substance abuse, and incarcerated). Nevertheless, healthcare stakeholders can conservatively consider that .8 million children and 1.4 million adults in the metropolitan French general population are likely to have ADHD and suffer from its multiple consequences.
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Affiliation(s)
- Hervé Caci
- Hôpitaux Pédiatrique de Nice, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France; Centre de recherche en Epidémiologie et Santé des Populations. Psychiatrie du Développement et Trajectoires (CESP), U1018 INSERM, Université Paris Saclay et Université de Versailles, Saint-Quentin-en-Yvelines, France.
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Bürgin D, Witt A, Seker S, d'Huart D, Meier M, Jenkel N, Boonmann C, Schmeck K, Fegert JM, Schmid M. Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis. Dev Psychopathol 2023:1-16. [PMID: 37990404 DOI: 10.1017/s0954579423001426] [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: 11/23/2023]
Abstract
Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry, University Psychiatric Services Berne, Berne, Switzerland
| | - Süheyla Seker
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Maria Meier
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Constance, Germany
| | - Nils Jenkel
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry - LUMC Curium, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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Toussaint E, Hardy A, Buchleither M. The physical and psychological health of children entrusted to the care of the child protection and welfare service in Vendée. Arch Pediatr 2023; 30:544-549. [PMID: 37798214 DOI: 10.1016/j.arcped.2023.08.008] [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: 01/17/2023] [Revised: 07/17/2023] [Accepted: 08/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The international literature has long established the importance of health issues presented by children entrusted to Child Protection and Welfare Service (Aide Sociale à l'Enfance -ASE, in France). This study examined the health of children entrusted to the ASE in Vendée (a French administrative region) in order to better understand and address their health needs. METHODS A retrospective study of all children (623 out of 920) aged 0-18 years placed in foster care or an institution during 2019 was carried out. The data collection was based on the information in the medical form completed by the doctor during the annual health check. RESULTS More than one quarter of the children had a written or spoken language disorder, 32% of children did not have a normal body mass index for their age, 10% of children suffered from enuresis, 4% from encopresis, and sleep disorders were observed in 29% of the study population. Furthermore, 51% of the children expressed psychological distress by internalizing or externalizing it, and 6% of children over 6 years of age had already run away or put themselves in danger. CONCLUSION The results of our study are congruent with the international literature and confirm that children and adolescents in out-of-home care (foster care, residential care) have significantly higher healthcare needs than their peers. The findings also suggest several areas for improving the healthcare of children and adolescents entrusted to the care of the child protection and welfare services.
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Affiliation(s)
- Emmanuelle Toussaint
- Maitre de conférence associé (PAST), Université de Nantes (EA 2661), 44312 Nantes. Psychologue Ph.D. EPSM Georges Mazurelle, 85000 La Roche sur Yon, France.
| | - Anne Hardy
- Médecin Référent Protection de l'Enfance, Direction Enfance et Famille / Service Aide Sociale à l'Enfance, Boulevard Aristide Briand, 85000 La Roche-sur-Yon, France
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21
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Essadek A, Musso M, Assous A, Widart F, Mathieu J, Robin M, Shadili G. Alcohol and psychoactive substance use in a cohort of children followed by child protection in France. Front Psychiatry 2023; 14:1180292. [PMID: 37953931 PMCID: PMC10634220 DOI: 10.3389/fpsyt.2023.1180292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background and aim Many studies have investigated the association between maltreatment and substance use in adulthood.In this study, we sought to explore the association between substance use during adolescence, diverse forms of child maltreatment, and psychological symptoms within a cohort of individuals under the purview of child protection services in France. Method The dataset was culled from a retrospective, population-based study encompassing minors and young adults aged 0 to 21, who were under the care of child protection services. Specifically, we conducted a comparative analysis between minors exhibiting substance use (N = 72) and those without such use (N = 776). Result The odds ratios predominantly illuminated a significant correlation between Substance Use and the manifestation of self-destructive behavior (OR = 4.35; CI 2.02-9.59), as well as aggressive behavior (OR = 5.75; CI 2.87-11.84). Univariate analysis also hinted at an association between SUD and suicidal ideation (OR = 3.52; CI 2.1-5.90). Conclusion Children in France who are in the care of child protection services and who use psychoactive substances are at greater risk of dropping out of school and of having other psychological symptoms. It is important that the public authorities take account of these results in order to adjust the care given to these minors, who often do not receive psychological support.
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Affiliation(s)
| | - Maeva Musso
- Department of Psychiatry, Hopital Saint-Maurice, Paris, France
| | | | - Frédéric Widart
- Department of Psychology, University of Liège, Liège, Belgium
| | - Joris Mathieu
- Université de Lorraine, INTERPSY, Nancy, France
- Centre Spécialisé de l’Obésité (CSO) et Service d’Endocrinologie, Diabétologie et Nutrition (EDN), CHRU-Nancy, Vandoeuvre-lès-Nancy, France
| | - Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- INSERM U1178, Team PsyDev, Villejuif, Paris, France
| | - Gérard Shadili
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
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22
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Benarous X, Lahaye H, Pellerin H, Consoli A, Cohen D, Labelle R, Renaud J, Gérardin P, El-Khoury F, van der Waerden J, Guilé JM. Hard-to-treat or hard-to-catch? Clinical features and therapeutic outcomes of help-seeking foster care youths with mood disorders. Front Psychiatry 2023; 14:1211516. [PMID: 37900296 PMCID: PMC10603296 DOI: 10.3389/fpsyt.2023.1211516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Introduction The high level of emotional problems in youths placed in foster care contrasts with the limited use of evidence-based treatments. This study aims to better characterize the clinical features and therapeutic outcomes of foster care youths with mood disorders. Methods A secondary analysis of data collected in the context of a French-Canadian clinical research network on pediatric mood disorders in four sites was conducted to compare three groups of patients with depressive or bipolar disorder: those without exposure to child welfare intervention (WCWI, n = 181), those who received non-placement psychosocial intervention (NPI, n = 62), and those in placement interventions (PI, n = 41). Results We observed a very high rate of academic problems in patients in the groups NPI/PI compared to those in the WCWI group. Patients in the PI group had more disruptive behavioral disorders (OR = 6.87, 95% CI [3.25-14.52]), trauma-related disorders (OR = 3.78, 95% CI [1.6-8.94]), and any neurodevelopmental disorders (OR = 2.73, 95% CI [1.36-5.49]) compared to the other groups (NPI/WCWI). Among inpatients, the Clinical Global Impression-Improvement scale and the change in the Children Global Assessment Scale during the hospital stay did not differ across the three groups. We observed a higher prescription rate of antipsychotics in the PI group compared to the NPI/WCWI groups, but no significant difference for antidepressants and mood stabilizers. Discussion These findings support the view that, when provided with dedicated support, fostered inpatient youths can improve in a range comparable to other inpatients. Undetected neurodevelopmental disorders and academic problems are likely important contributors of the burden of mood disorders in these youths.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hélène Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hugues Pellerin
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
- CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France
| | - Réal Labelle
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Priscille Gérardin
- Department of Child and Adolescent Psychopathology, Rouen University Hospital, Rouen, France
| | - Fabienne El-Khoury
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
- Pôle de psychiatrie de l’enfant et de l’adolescent, Etablissement Publique de Santé Mentale de la Somme, Paris, France
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23
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Haune M, Nissen A, Christiansen Ø, Myrvold TM, Ruud T, Heiervang ER. Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01619-5. [PMID: 37828418 DOI: 10.1007/s10578-023-01619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0-17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0-6 and 3.3 for children aged 7-17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.
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Affiliation(s)
- Monica Haune
- Institute of Clinical Medicine, University of Oslo, Blindern, P.O box 1171, Oslo, 0318, Norway.
| | - Alexander Nissen
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Øivin Christiansen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Trine M Myrvold
- Norwegian Institute for Urban and Regional Research, Oslo Metropolitan University, Oslo, Norway
| | - Torleif Ruud
- Institute of Clinical Medicine, University of Oslo, Blindern, P.O box 1171, Oslo, 0318, Norway
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Einar R Heiervang
- Institute of Clinical Medicine, University of Oslo, Blindern, P.O box 1171, Oslo, 0318, Norway
- Oslo University Hospital, Oslo, Norway
- Innlandet Hospital Trust, Innlandet, Norway
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24
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Sklar M, Kenneally R, Aarons GA, Fettes DL. Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol. Implement Sci Commun 2023; 4:121. [PMID: 37798808 PMCID: PMC10552205 DOI: 10.1186/s43058-023-00479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Half of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services' intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended. METHODS Using a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services' intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed. DISCUSSION By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes. TRIAL REGISTRATION NCT05629013. Approval date: November 28, 2022 (version 1). TRIAL SPONSOR University of California, San Diego. RESPONSIBLE PARTY Danielle Fettes.
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Affiliation(s)
- Marisa Sklar
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Ryan Kenneally
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Danielle L Fettes
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA.
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
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25
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Xu Y, Winters AM, Soto-Ramírez N, McCarthy L, Betz G, Liu M. Predisposing, Enabling, and Need Factors Associated with Psychotropic Medication and Mental Health Service Use among Children in Out-of-Home Care in the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6769. [PMID: 37754629 PMCID: PMC10531290 DOI: 10.3390/ijerph20186769] [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: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
This scoping review aimed to identify predisposing, enabling, and need factors associated with the use of mental health services, including psychotropic medications, among children in out-of-home care in the United States. We searched the PsycInfo, SocINDEX, Medline, and Scopus databases, and 22 studies met inclusion criteria and were systematically analyzed. Among the included studies, 7 studies examined predictors associated with taking psychotropic medications, and 16 examined factors associated with using other mental health services. Significant predisposing, enabling, and need factors associated with greater use of mental health services, including psychotropic medications, were identified. The most frequently identified predisposing factors were child race/ethnicity, age, gender, and maltreatment. Important enabling factors were out-of-home placement type and length of care, and need factors included children's mental/behavioral problems. The results provide insight into maximizing factors facilitating children's use of mental health services to address mental health problems of children in out-of-home care. Further, the results imply the importance of the appropriate use of psychotropic medication (e.g., the type and dosage of medications) among children in out-of-home care. The identified factors can inform child welfare agencies and stakeholders on ways to improve access to mental health services and the appropriate use of psychotropic medications among children in out-of-home care in the United States.
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Affiliation(s)
- Yanfeng Xu
- College of Social Work, University of South Carolina, 1512 Pendleton St., Columbia, SC 29208, USA
| | - Andrew M. Winters
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY 40292, USA;
| | - Nelís Soto-Ramírez
- Center for Child and Family Studies, College of Social Work, University of South Carolina, Columbia, SC 29208, USA;
| | - Lauren McCarthy
- Children’s Hospital Colorado, University of Colorado, Aurora, CO 80045, USA;
| | - Gail Betz
- University of Maryland, Baltimore, MD 21201, USA;
| | - Meirong Liu
- School of Social Work, Howard University, Washington, DC 20059, USA;
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26
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Muzi S, Pace CS. Attachment and alexithymia predict emotional-behavioural problems of institutionalized, late-adopted and community adolescents: An explorative multi-informant mixed-method study. Clin Psychol Psychother 2023; 30:1130-1145. [PMID: 37259169 DOI: 10.1002/cpp.2862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Compared to community adolescents (COM), adolescents placed in residential care (RC) or late adopted (LA) appear to show more emotional-behavioural problems. They also appear vulnerable in variables linked to emotional-behavioural problems, such as insecure-disorganized attachment and alexithymia. This study employs a mixed-method multi-informant approach to (1) compare adolescents placed in RC, LA and COM in emotional-behavioural problems, attachment and alexithymia and (2) investigate relationships and interplay of attachment and alexithymia concerning emotional-behavioural problems in these three groups. METHOD Participants were 174 adolescents (50 RC, 33 LA and 91 COM; Mage = 15, 53% boys and 47% girls). Adolescents' internalizing and externalizing problems were assessed through both caregiver-reported and self-reported questionnaires, while attachment and alexithymia were assessed with a mixed method, using interviews and self-report questionnaires. RESULTS The results showed RC adolescents as more vulnerable in all variables, while LA and COM did not differ. Accounting for the group, attachment and alexithymia cumulatively predicted 25-43% of internalizing problems, and 19-43% of externalizing problems depending on the method of assessment or problems' informant (all p < 0.01). Alexithymia was both an independent predictor and interacted with preoccupied attachment in predicting internalizing problems, while no predictors were isolated for externalizing ones, and the group never indicate an effect on problems' rates. CONCLUSIONS The authors discuss the utility to maintain a research focus on attachment and alexithymia, also suggesting future directions of research. A need to determine potential distortions of results because of problems' informant and method of assessment is also highlighted.
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Affiliation(s)
- Stefania Muzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Serena Pace
- Department of Educational Sciences, University of Genoa, Genoa, Italy
- Centro Italiano Aiuti all'Infanzia (CIAI), Genoa, Italy
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27
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Haggerty KP, Barkan SE, Caouette JD, Skinner ML, Hanson KG. Family, Mental Health, and Placement Outcomes of a Low-cost Preventive Intervention for Youth in Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2023; 150:106973. [PMID: 37234457 PMCID: PMC10208435 DOI: 10.1016/j.childyouth.2023.106973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16 - 17) but not younger youth (ages 13 - 15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting's driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.
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Affiliation(s)
- Kevin P Haggerty
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Susan E Barkan
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Justin D Caouette
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Martie L Skinner
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Koren G Hanson
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
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28
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Evans R, MacDonald S, Trubey R, Noyes J, Robling M, Willis S, Boffey M, Wooders C, Vinnicombe S, Melendez-Torres GJ. Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review. Syst Rev 2023; 12:111. [PMID: 37393358 PMCID: PMC10315047 DOI: 10.1186/s13643-023-02260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/26/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years. METHODS For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics. RESULTS In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes. CONCLUSIONS Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020177478.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK.
| | - Sarah MacDonald
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | - Simone Willis
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Maria Boffey
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | | | - Soo Vinnicombe
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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29
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McKenna S, O’Reilly D, Maguire A. The mental health of all children in contact with social services: a population-wide record-linkage study in Northern Ireland. Epidemiol Psychiatr Sci 2023; 32:e35. [PMID: 37190768 PMCID: PMC10227534 DOI: 10.1017/s2045796023000276] [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: 01/24/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023] Open
Abstract
AIMS Children in contact with social services are at high risk for mental ill health, but it is not known what proportion of the child population has contact with social services or how risk varies within this group compared to unexposed peers. We aim to quantify the extent and nature of contact with social services within the child population in Northern Ireland (NI) and the association with mental ill health. We also examine which social care experiences identify those most at risk. METHODS This is a population-based record-linkage study of 497,269 children (aged under 18 years) alive and resident in NI in 2015 using routinely collected health and social care data. Exposure was categorized as (1) no contact, (2) referred but assessed as not in need (NIN), (3) child in need (CIN) and (4) child in care (CIC). Multilevel logistic regression analyses estimated odds ratios (ORs) for mental ill health indicated by receipt of psychotropic medication (antidepressants, anxiolytics, antipsychotics and hypnotics), psychiatric hospital admission and hospital-presenting self-harm or ideation. RESULTS Over one in six children (17.2%, n = 85,792) were currently or previously in contact with social services, and almost one child in every 20 (4.8%, n = 23,975) had contact in 2015. Likelihood of any mental ill health outcome increased incrementally with the level of contact with social services relative to unexposed peers: NIN (OR 5.90 [95% confidence interval (CI) 5.10-6.83]), CIN (OR 5.99 [95% CI 5.50-6.53]) and CIC (OR 12.60 [95% CI 10.63-14.95]). All tiers of contact, number of referrals, number of care episodes and placement type were strongly associated with the likelihood of mental ill health. CONCLUSION Children who have contact with social services account for a large and disproportionate amount of mental ill health in the child population. Likelihood of poor mental health across indicators is highest in care experienced children but also extends to the much larger population of children in contact with social services but never in care. Findings suggest a need for targeted mental health screening and enhanced support for all children in contact with social services.
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Affiliation(s)
- Sarah McKenna
- Administrative Data Research Centre Northern Ireland (ADRC-NI), Queen’s University Belfast, Belfast, Northern Ireland
| | - Dermot O’Reilly
- Administrative Data Research Centre Northern Ireland (ADRC-NI), Queen’s University Belfast, Belfast, Northern Ireland
| | - Aideen Maguire
- Administrative Data Research Centre Northern Ireland (ADRC-NI), Queen’s University Belfast, Belfast, Northern Ireland
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30
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Zhou Z, Wei D, Liu W, Chen H, Qin S, Xu P, Zuo XN, Luo YJ, Qiu J. Gene transcriptional expression of cortical thinning during childhood and adolescence. Hum Brain Mapp 2023. [PMID: 37146003 DOI: 10.1002/hbm.26328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
The cognitive and behavioral development of children and adolescents is closely related to the maturation of brain morphology. Although the trajectory of brain development has been depicted in detail, the underlying biological mechanism of normal cortical morphological development in childhood and adolescence remains unclear. By combining the Allen Human Brain Atlas dataset with two single-site magnetic resonance imaging data including 427 and 733 subjects from China and the United States, respectively, we performed partial least squares regression and enrichment analysis to explore the relationship between the gene transcriptional expression and the development of cortical thickness in childhood and adolescence. We found that the spatial model of normal cortical thinning during childhood and adolescence is associated with genes expressed predominantly in astrocytes, microglia, excitatory and inhibitory neurons. Top cortical development-related genes are enriched for energy-related and DNA-related terms and are associated with psychological and cognitive disorders. Interestingly, there is a great deal of similarity between the findings derived from the two single-site datasets. This fills the gap between early cortical development and transcriptomes, which promotes an integrative understanding of the potential biological neural mechanisms.
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Affiliation(s)
- Zheyi Zhou
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Dongtao Wei
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Wei Liu
- School of Psychology, Central China Normal University, Wuhan, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Shaozheng Qin
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xi-Nian Zuo
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- National Basic Science Data Center, Beijing, China
| | - Yue-Jia Luo
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Beijing, China
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31
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Tärnhäll A, Björk J, Wallinius M, Gustafsson P, Billstedt E, Hofvander B. Healthcare utilization and psychiatric morbidity in violent offenders: findings from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:617-628. [PMID: 36574014 PMCID: PMC10066109 DOI: 10.1007/s00127-022-02408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known of their psychiatric healthcare utilization (HCU) and HCU-associated factors. This study aimed to explore psychiatric HCU, psychiatric morbidity, and psychotropic prescription drugs in violent offenders with a history of incarceration. METHODS Male offenders aged 18-25 (n = 266) imprisoned for violent and/or physical sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries through 2017. Register-based information regarding HCU, psychiatric morbidity, and psychotropic drugs was tracked and compared with a general population group (n = 10,000) and across offending trajectory groups. Baseline risk factors were used to explain prospective psychiatric HCU in violent offenders. RESULTS Violent offenders used less general healthcare and psychiatric outpatient care, but more psychiatric inpatient care and were more often given psychiatric diagnoses and psychotropic drugs than the general population. Participants previously assigned to persisting offending trajectory groups had higher rates of psychiatric HCU than those assigned to a desisting trajectory. In multivariable regression models, psychiatric HCU was associated with anxiety disorders, prior psychiatric contact, placement in a foster home, psychopathic traits, low intellectual functioning, and persistent offending. CONCLUSIONS Violent offenders are burdened by extensive and serious psychiatric morbidity and typically interact with psychiatric healthcare as inpatients rather than outpatients. Knowledge about their backgrounds, criminal behaviors, and psychiatric statuses can aid the planning of psychiatric services for this troublesome group.
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Affiliation(s)
- André Tärnhäll
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden.
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden.
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Peik Gustafsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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32
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Davis RS, Halligan SL, Meiser-Stedman R, Elliott E, Ward G, Hiller RM. A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care. Res Child Adolesc Psychopathol 2023; 51:485-496. [PMID: 36525227 PMCID: PMC10017561 DOI: 10.1007/s10802-022-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.
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Affiliation(s)
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | | | - Georgina Ward
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Rachel M Hiller
- Department of Psychology, University of Bath, Bath, UK. .,Division of Psychology and Language Sciences, University College London, London, UK. .,Anna Freud National Centre for Children and Families, London, UK.
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33
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Lee H, Rauktis ME, Mulzet M, Jenkins AS. A Mixed-Methods Study Exploring the Educational Experiences of Foster Youth and Foster Parents During COVID-19. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2023:1-25. [PMID: 37363070 PMCID: PMC10024912 DOI: 10.1007/s10560-023-00922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/28/2023]
Abstract
The COVID-19 pandemic and measures taken to decrease the spread impacted youth in foster care and foster parents in a myriad of ways. One critical yet unexplored area is how educational changes during the first 2 years of the pandemic impacted this specific group of youth in foster care and foster parents. This exploratory study used three methods: (1) A scoping review of the prior research on pandemics/climate events and school closures and the research from early 2020; (2) individual interviews and focus groups with foster parents and teachers; and (3) an online survey of 88 foster parents. We endeavored to include findings at each stage of the process. Research from prior epidemics and school closures and predictive models predicted learning losses which were verified by the findings in the survey and interviews. Foster parents reported that the youth in foster care had great difficulty concentrating with on-line delivery and the absence or greatly limited access to mental health services compounded the challenges. Even as children returned to classrooms, the behavior of children, youth resulted in suspensions and expulsions likely increasing learning losses. The discussion identifies some approaches to addressing COVID-19 learning gaps and the mental health needs of this vulnerable group of children and youth.
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Affiliation(s)
- Hyunji Lee
- Florida Institute for Child Welfare, Florida State University, Tallahassee, FL USA
| | - Mary E. Rauktis
- School of Social Work, University of Pittsburgh, Pittsburgh, PA USA
| | - Morgan Mulzet
- Information Sciences, University of Pittsburgh, Pittsburgh, PA USA
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Rau T, Mayer S, Keller F, Allroggen M. [Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:127-138. [PMID: 35611610 DOI: 10.1024/1422-4917/a000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.
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Affiliation(s)
- Thea Rau
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Sophia Mayer
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Ferdinand Keller
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Deutschland
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Dawe S, Eggins E, Betts J, Webster H, Pomario T, Doak J, Chandler-Mather N, Hatzis D, Till H, Harnett P, Wood A, Shelton D. An investigation of the utility of the Australian Guide to the diagnosis of fetal alcohol spectrum disorder in young children. Alcohol Clin Exp Res 2023; 47:486-500. [PMID: 36810987 DOI: 10.1111/acer.15012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Early diagnosis of children with fetal alcohol spectrum disorder (FASD) assists in implementing critical early support. The challenge lies in having a diagnostic process that enables valid and reliable assessment of domains of functioning in young children, with the added complexity that many children will also have co-occurring exposure to childhood adversity that is likely to impact these domains. METHODS The aim of this study was to test a diagnostic assessment of FASD in young children using the Australian Guide to the Diagnosis of FASD. Ninety-four children (aged 3 to 7 years) with confirmed or suspected prenatal alcohol exposure were referred to two specialist FASD clinics for assessment in Queensland, Australia. RESULTS There was a significant risk profile with 68.1% (n = 64) children having had contact with child protection services, and most children living in kinship (n = 22, 27.7%) or foster (n = 36, 40.4%) care. Forty-one percent of the children were Indigenous Australians. The majority (64.9%, n = 61) of children met criteria for FASD, 30.9% were classified as "At Risk" for FASD (n = 29), and 4.3% received no FASD diagnosis (n = 4). Only 4 (4%) children were rated as severe for the brain domain. Over 60% of children (n = 58) had two or more comorbid diagnoses. Sensitivity analyses indicated that the removal of comorbid diagnoses in the Attention, Affect Regulation, or Adaptive Functioning domains resulted in a change in 7 of 47 cases (15%) to an "At Risk" designation. CONCLUSIONS These results highlight the complexity of presentation and the extent of impairment in the sample. The use of comorbid diagnoses to substantiate a "severe" designation in specific neurodevelopmental domains raises the question of whether there were false-positive diagnoses. The complexity of determining causal relationships between exposure to PAE and early life adversity on developmental outcomes continues to be a challenge in this young population.
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Affiliation(s)
- Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Elizabeth Eggins
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joseph Betts
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Heidi Webster
- Child Development Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Tania Pomario
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Doak
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ned Chandler-Mather
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Denise Hatzis
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Haydn Till
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
| | - Paul Harnett
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Wood
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Doug Shelton
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
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36
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Sölva K, Haselgruber A, Lueger-Schuster B. Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care. BMC Psychol 2023; 11:30. [PMID: 36717951 PMCID: PMC9887823 DOI: 10.1186/s40359-023-01049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ2 testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.
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Affiliation(s)
- Katharina Sölva
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
| | - Alexander Haselgruber
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
| | - Brigitte Lueger-Schuster
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
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37
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Bunger AC, Yoon S, Maguire-Jack K, Phillips R, West KY, Clark-Hammond G, Kranich C. Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:327-341. [PMID: 36449108 PMCID: PMC9931844 DOI: 10.1007/s10488-022-01238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.
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Affiliation(s)
- Alicia C. Bunger
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | - Rebecca Phillips
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | | | - Christiana Kranich
- Government Resource Center, Ohio Colleges of Medicine, Columbus, OH 43210 USA
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Hiller RM, Lehmann S, Lewis SJ, Minnis H, Shelton KH, Tarren-Sweeney M, Taussig HN. Accommodating Complexity: The Need for Evidence-Informed Mental Health Assessments for Children in Out-of-Home Care. J Am Acad Child Adolesc Psychiatry 2023; 62:12-18. [PMID: 35987299 DOI: 10.1016/j.jaac.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, United Kingdom; Anna Freud National Centre for Children and Families, London, United Kingdom.
| | - Stine Lehmann
- Faculty of Psychology, University of Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare - West, NORCE Norwegian Research Centre, Bergen, Norway
| | - Stephanie J Lewis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, United Kingdom
| | | | | | - Heather N Taussig
- Graduate School of Social Work, University of Denver, Colorado; Kempe Center, University of Colorado School of Medicine, Aurora, Colorado
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O'Hare K, Hussain A, Laurens KR, Hindmarsh G, Carr VJ, Tzoumakis S, Harris F, Green MJ. Self-reported mental health of children known to child protection services: an Australian population-based record linkage study. Eur Child Adolesc Psychiatry 2023; 32:101-112. [PMID: 34247296 DOI: 10.1007/s00787-021-01841-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Maltreated children are vulnerable to adverse mental health outcomes. Information about how children's mental health needs vary according to different levels of child protection contact (potentially culminating in out-of-home care [OOHC]) is valuable for the effective provision of services. This study aimed to examine associations between different levels of contact with child protection services before the age of 10 years and self-reported mental health difficulties at age 11 years. Participants (n = 26,960) were drawn from the New South Wales Child Development Study, a multiagency, multigenerational, longitudinal record linkage study that combines administrative records with cross-sectional survey data. We examined associations between four levels of child protection response (non-threshold reports, unsubstantiated reports, substantiated reports, OOHC; each relative to no report) and six domains of self-reported mental health difficulties (including internalising and externalising symptoms, and psychotic-like experiences). All levels of contact with child protection services were associated with increased odds of mental health difficulties in all domains. Children who had been placed in OOHC and children with substantiated reports had the highest odds of reporting clinical levels of mental health difficulties; 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports showed clinical levels of mental health difficulties in at least one domain. Children with child protection reports that were unsubstantiated, or determined not to meet the threshold for risk-of-significant harm, were also at increased risk of mental health difficulties in middle childhood. These findings underscore the importance of early detection and intervention for all children at risk of maltreatment.
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Affiliation(s)
- Kirstie O'Hare
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Aniqa Hussain
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia.,School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
| | - Gabrielle Hindmarsh
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia.,Neuroscience Research Australia, Sydney, Australia.,Department of Psychiatry, Monash University, Melbourne, Australia
| | - Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Southport, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia. .,Neuroscience Research Australia, Sydney, Australia.
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40
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Putnam-Hornstein E, Foust R, Cuccaro-Alamin S, Prindle J, Nghiem H, Ahn E, Palmer L. A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children. J Pediatr 2023; 252:117-123. [PMID: 36027974 DOI: 10.1016/j.jpeds.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18 years old in California based on levels of current and past child protection system (CPS) involvement. STUDY DESIGN In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n = 3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes. RESULTS Overall, 14% (n = 470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care. CONCLUSIONS Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.
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Affiliation(s)
- Emily Putnam-Hornstein
- Children's Data Network, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Children's Data Network, University of Southern California, Los Angeles, CA, USA; California Child Welfare Indicators Project, University of California at Berkeley, Berkeley, CA, USA.
| | - Regan Foust
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Cuccaro-Alamin
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; California Child Welfare Indicators Project, University of California at Berkeley, Berkeley, CA, USA
| | - John Prindle
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Huy Nghiem
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Eunhye Ahn
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Lindsey Palmer
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; Child Maltreatment Solutions Network, Pennsylvania State University, State College, PA, USA
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Sacco R, Camilleri N, Eberhardt J, Umla-Runge K, Newbury-Birch D. A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-02131-2. [PMID: 36581685 PMCID: PMC9800241 DOI: 10.1007/s00787-022-02131-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.
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Affiliation(s)
- Rosemarie Sacco
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK.
- School of Medicine, Cardiff University, Cardiff, Wales.
- School of Medicine and Surgery, University of Malta, Msida, Malta.
- Mental Health Services, Attard, Malta.
| | - Nigel Camilleri
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
- School of Medicine and Surgery, University of Malta, Msida, Malta
- Mental Health Services, Attard, Malta
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | | | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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Adaptive Behavior in Slovak Children with Intellectual Disability in Institutional Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121911. [PMID: 36553354 PMCID: PMC9777255 DOI: 10.3390/children9121911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to analyze the adaptive skills of children with intellectual disabilities in institutional care. We focused on communication, socialization, daily living skills and their relationship with risk factors, and institutional care. Our sample included 197 children aged 5−18 years (M = 12.8, SD = 2.97), 50% boys, with IQ < 85 placed in different types and lengths of stay in institutional care. There were 17% that presented with borderline intellectual functioning (IQ 84−87) and 83% that had intellect disabilities. Adaptive behavior (AB) was assessed by Vineland Adaptive Behavior Scale (VABS-3). The BIF and Mild ID groups did not differ in Socialization. The profile of adaptive behavior for BIF and Mild ID was Daily Living Skills > Communication > Socialization, and for Moderate and Severe ID, Socialization > Daily Living Skills > Communication. Longer institutional care was associated with lower competencies in AB. Gender differences were found, females overperformed males in Socialization, Daily Living Skills, and ABC score. Levels of ID, gender, length of stay in institutional care, and neonatal difficulties were significant predictors in the model which explain the 63% variance of AB. The practical implications of the results are discussed related to the assessment of ID, prevention, and care for institutionalized children.
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Prince DM, Ray-Novak M, Gillani B, Peterson E. Sexual and Gender Minority Youth in Foster Care: An Evidence-Based Theoretical Conceptual Model of Disproportionality and Psychological Comorbidities. TRAUMA, VIOLENCE & ABUSE 2022; 23:1643-1657. [PMID: 33942681 DOI: 10.1177/15248380211013129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual and gender minority youth (SGMY) are overrepresented in the foster care system and experience greater foster-care-related stressors than their non-SGM peers. These factors may further elevate their risk of anxiety/depressive, post-traumatic stress disorder, self-harm, and suicidality. The system currently produces unequal and disproportionate adverse mental health outcomes for SGMY and needs points of intervention to disrupt this status quo. This article provides an empirically grounded conceptual-theoretical model of disproportionate representation and burden of psychological comorbidities experienced by SGMY in the foster care system. We apply findings from an integrated literature review of empirical research on factors related to overrepresentation and mental health burden among SGMY to minority stress theory to explicate how and why the foster care system exacerbates mental health comorbidities for SGMY. Searches were conducted in June 2020 in PubMed using MeSH terms and title/abstract terms for foster care, sexual or gender minorities, and psychological comorbidities. Inclusion criteria are studies conducted in the United States, published in English, focused on mental illness, and published between June 2010 and 2020. Developmental/intellectual and eating disorders were excluded. The initial search returned 490 results. After applying inclusion criteria, 229 results remained and are utilized to build our conceptual-theoretical model. We assert that the phenomenon of disproportionate psychological comorbidities for SGMY in foster care is best represented as a complex and dynamic system with multiple feedback loops. Extant empirical and theoretical literature identifies three critical areas for intervention: family acceptance, community belonging and queer chosen/constructed family, and affirming and nondiscriminatory child welfare policy.
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Affiliation(s)
- Dana M Prince
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 2546Case Western Reserve University, Cleveland, OH, USA
| | - Meagan Ray-Novak
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 2546Case Western Reserve University, Cleveland, OH, USA
| | - Braveheart Gillani
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 2546Case Western Reserve University, Cleveland, OH, USA
| | - Emily Peterson
- Department of Psychological Sciences, 2546Case Western Reserve University, Cleveland, OH, USA
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McWey LM, Cui M, Wojciak AS. Parent and Caregiver Relationships and Mental Health Symptom Profiles of Youth in Foster Care. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 39:573-581. [PMID: 37829099 PMCID: PMC10569441 DOI: 10.1007/s10560-022-00834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/14/2023]
Abstract
Adolescents in foster care can be quite resilient, yet they also are at risk for developing internalizing and externalizing mental health concerns. Positive family relationships are central to adolescent mental health, and these relationships can be complex for youth in foster care placements. Accordingly, there can be significant heterogeneity in the mental health symptoms of youth in foster care. The aims of this study were to identify distinct subgroups of youth patterns of internalizing and externalizing symptoms and determine the extent to which positive biological and foster parent relationships predicted profiles of low youth mental health symptoms. Using data from the National Survey of Child and Adolescent Well-being II (N = 343) and a person-centered analytic approach, results revealed four distinct profiles of youths' mental health symptoms, those with: high internalizing and high externalizing symptoms, high internalizing and moderate externalizing symptoms, moderate internalizing and moderate externalizing symptoms, and low internalizing and low externalizing symptoms. Additionally, youth with better relationships with biological parents were less likely to be in the high symptoms group compared to the low symptoms group. These findings can be used to inform targeted intervention efforts aimed to lessen the mental health symptoms of youth in foster care.
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Affiliation(s)
- Lenore M. McWey
- Department of Human Development and Family Science, Florida State University, Tallahassee, FL, USA
| | - Ming Cui
- Department of Human Development and Family Science, Florida State University, Tallahassee, FL, USA
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Bradford DRR, Allik M, McMahon AD, Brown D. Physical health of care-experienced young children in high-income countries: a scoping review protocol. BMJ Open 2022; 12:e063648. [PMID: 36691175 PMCID: PMC9454045 DOI: 10.1136/bmjopen-2022-063648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Care-experienced children have poorer health, developmental, and quality of life outcomes across the lifespan compared to children who are not in care. These inequities begin to manifest in the early years. The purpose of the proposed scoping review is to collate and synthesise studies of the physical health of young care-experienced children. The results of the review will help map the distribution of health outcomes, identify potential targets for intervention, and assess gaps in the literature relating to this group. METHODS AND ANALYSIS We will carry out a scoping review of the literature to identify studies of physical health outcomes in care-experienced children. Systematic literature searches will be carried out on the MEDLINE, CINAHL and Web of Science Core Collection databases for items indexed on or before 31 August 2022. Studies will be included where the participants are aged 3 months or greater and less than 6 years. Data elements extracted from included studies will include study objectives, health outcomes, participant demographics, care setting characteristics and bibliographic information. The results of the review will be synthesised and reported using a critical narrative approach. Comparisons between care and non-care populations will be reported if sufficient studies are identified. ETHICS AND DISSEMINATION Data will be extracted from publicly available sources, so no additional ethical approval is required. Results will be published in a peer-reviewed journal article. Furthermore, they will be shared in summary reports and presented to local authorities, care organisations and other relevant stakeholders that can influence healthcare policy and procedure relating to young children in care.
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Affiliation(s)
- Daniel R R Bradford
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alex D McMahon
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Edwards D, Collin-Vézina D, Danbrook MC, Wekerle C. Longitudinal trajectories of depressive symptoms among sexually abused adolescents involved in child protection services. CHILD ABUSE & NEGLECT 2022; 131:105742. [PMID: 35724487 DOI: 10.1016/j.chiabu.2022.105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Childhood sexual abuse (CSA) contributes to depression in several populations. However, there is a significant lack of longitudinal research on depressive symptoms among sexually abused adolescents involved in Child Protection Services (CPS). Given the systemic challenges in CPS research, it is also unclear as to whether depressive symptoms vary according to CSA severity. OBJECTIVE The research aimed to determine whether depressive symptoms increased over time and to assess whether CSA severity predicted the variation of change in depressive symptoms over time. PARTICIPANTS AND SETTING The study included 135 sexually abused adolescents (M = 16.01, 71.9 % female) from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study who were involved in three densely populated urban CPS agencies in Ontario, Canada. METHODS The project involved the collection of self-report questionnaires to be completed every six-months for three years. The questionnaires encompassed measures on psychological outcomes, selected resiliency factors, and abuse and neglect history. Hierarchical Linear Modeling (HLM) via mixed model analyses were used to estimate depressive symptom trajectories. RESULTS We found that depressive symptoms significantly reduced over time (β. = -3.62, p < .001). Furthermore, the results showed that CSA severity significantly predicted depressive symptoms over time (β = 0.19, p < .001). CONCLUSIONS The findings contrast previous longitudinal research in community-based samples, suggesting a different trajectory for depressive symptoms among sexually abused adolescents involved in CPS. Moreover, the results reveal a strong association between depressive symptoms and CSA severity, further supporting early mental health screening practices.
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Affiliation(s)
- Damyan Edwards
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y9, Canada.
| | - Delphine Collin-Vézina
- School of Social Work, Centre for Research on Children and Families, McGill University, 3506 University, Suite 321A, Montreal, QC H3A 2A7, Canada.
| | - Matthew C Danbrook
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y9, Canada.
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
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Mowbray O, Probert K, Jaramillo J, Kothari BH, McBeath B. Trajectories of mental health services for youth in foster care with attention deficit hyperactivity disorder. CHILDREN AND YOUTH SERVICES REVIEW 2022; 140:106599. [PMID: 35910531 PMCID: PMC9337625 DOI: 10.1016/j.childyouth.2022.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Youth in foster care with Attention Deficit Hyperactivity Disorder (ADHD) often have significant needs for mental health services. The degree to which youth taking medication for ADHD use mental health services in relation to sibling co-placement and their level of need over time is unclear. To examine these issues, caregivers (N = 54) provided information on youth mental health service use across an 18-month study period. Results show that siblings living apart had a higher probability of mental health service use. For youth with higher CBCL scores, probability of mental health service use was both high and stable over time. However, youth with lower CBCL scores showed a decrease in probability of mental health service use over time. The sustained commitment to receipt of mental health services among youth with ADHD is something all behavioral health providers who work with foster care involved youth can benefit from, as well as the youth themselves.
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Affiliation(s)
- Orion Mowbray
- University of Georgia, 279 Williams, St. Athens, GA 30677, United States
| | - Kylee Probert
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Jamie Jaramillo
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Brianne H. Kothari
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Bowen McBeath
- Portland State University School of Social Work, 1800 SW 6th Ave, Portland, OR 97201, United States
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48
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Sheerin KM, Modrowski CA, Williamson S, Kemp KA. The Effect of Sexual Concerns on Placement Changes and School Transfers for Youth in the Child Welfare System. CHILDREN AND YOUTH SERVICES REVIEW 2022; 138:106520. [PMID: 38223234 PMCID: PMC10785607 DOI: 10.1016/j.childyouth.2022.106520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Youths in the child welfare system experience high rates of placement changes and school transfers; therefore, prior research focused on variables that may be linked with such disruptions. Indeed, researchers have established that mental health symptoms (e.g., PTSD symptoms) are linked with placement disruptions. However, an important aspect of mental health for youth in the child welfare system has largely been ignored: sexual concerns (e.g., distress, preoccupation). Thus, the present study evaluated whether higher levels of sexual preoccupation and distress among a sample of child welfare-involved youths (N = 124) in a northeastern state predicted placement changes and school transfers above and beyond variables previously linked with these disruptions. Our hypotheses were partially supported such that higher levels of sexual distress were linked with increased odds of experiencing a placement change (OE = 2.60; p <.01). Counter to our hypotheses, higher levels of sexual preoccupation were linked with lower odds of experiencing both placement changes (OE = -2.98; p <.01) and school transfers (OR = 0.18; p < .05). Furthermore, sexual preoccupation and sexual distress were not linked with increased rates of placement changes. The current findings have implications for the assessment of sexual concerns and the prevention of placement changes among youth in the child welfare system.
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Affiliation(s)
| | - Crosby A. Modrowski
- Warren Alpert Medical School of Brown University
- Hasbro Children’s Research Center/Rhode Island Hospital
| | | | - Kathleen A. Kemp
- Warren Alpert Medical School of Brown University
- Hasbro Children’s Research Center/Rhode Island Hospital
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Nissinen NM, Sarkola T, Autti-Rämö I, Gissler M, Kahila H, Koponen AM. Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study. J Affect Disord 2022; 308:328-336. [PMID: 35439464 DOI: 10.1016/j.jad.2022.04.039] [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: 09/22/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prenatal substance exposure is associated with mood and neurotic disorders but this association is complex and understudied. This study investigated the recorded use of specialised healthcare services for mood and neurotic disorders among youth with prenatal substance exposure in comparison with an unexposed matched cohort. Furthermore, the influence of adverse maternal characteristics and out-of-home care (OHC) is investigated. METHODS This longitudinal register-based matched cohort study included 594 exposed and 1735 unexposed youth. Cox proportional hazard regression models were applied to study the first episode of mood and neurotic disorders in specialised healthcare from 13 years of age, and the influence of adverse maternal characteristics and OHC. Mediation analysis was applied to study the mediating effect of OHC on the association between prenatal substance exposure and the disorders. RESULTS The exposed cohort had a two-fold higher likelihood of being treated at specialised healthcare for mood and neurotic disorders compared with the unexposed cohort (HR 2.34, 95% CI 1.86-2.95), but this difference was attenuated to non-significant levels (AHR 1.29, 95% CI 0.92-1.81) following adjustments with adverse maternal characteristics and OHC. OHC mediated 61% (95% CI 0.41-0.94) of the association between prenatal substance exposure and youth's mood and neurotic disorders. LIMITATIONS Register data likely include more severe cases of disorders, and as an observational study, causality cannot be assessed. CONCLUSION Mood and neurotic disorders are more common following prenatal exposure to substances and interlinked with significant adversities in the postnatal caregiving environment and OHC.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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Olashore AA, Brooks W, Roy H, Adebayo FA, Chiliza B. Psychiatric disorders and associated risk factors in a sample of adolescents in Gaborone, Botswana: a cross-sectional study. BMC Pediatr 2022; 22:381. [PMID: 35768787 PMCID: PMC9244366 DOI: 10.1186/s12887-022-03435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the high proportion of adolescents living with mental health issues in low- to middle-income countries (LMICs), especially in Botswana, there is a significant deficit of local research to guide an increase in prevention and treatment. We, therefore, aimed to assess the prevalence and associated risk factors of psychiatric disorders (PD) in a sample of secondary school students in Botswana. Methods This cross-sectional study included 750 students from the 13 public secondary schools in Gaborone using a multi-stage sampling technique. The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used to screen for PDs. Results The participant’s mean age was 15.26 and SD 1.57 years, with 53.6% being female. Approximately 34% had a PD, with depression being the commonest, of whom 35% were neither receiving treatment nor aware of the available services. Perinatal complications (AOR = 4.29; 95%CI: 1.04–17.70), a family history of mental illness (AOR = 2.19; 95%CI: 1.17–4.11) and substance-related problems (AOR = 1.80; 95% CI:1.22–2.65) predicted the likelihood of developing PD. Conclusions Our findings revealed that adolescents in Botswana have many mental health issues which may affect their developmental phases. A multi-sectoral collaboration is needed for the timely detection of identified risk factors and initiation of the necessary prevention and treatment measures.
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Affiliation(s)
- Anthony A Olashore
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana. .,Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Wendy Brooks
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Hlanganiso Roy
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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