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Schwartzman JM, Williams ZJ, Molnar AE. Parent and Provider Differences in Ratings of Mental Health and Neurodevelopmental Concerns in Children with Neurologic Disorders. J Clin Psychol Med Settings 2024; 31:526-536. [PMID: 38400951 PMCID: PMC11333177 DOI: 10.1007/s10880-023-09990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/26/2024]
Abstract
Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0-17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ = .324), better agreement for neurodevelopmental concerns (κ = .511), and low sensitivity of referring providers (Se = .326) and parents (Se = .366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders.
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Affiliation(s)
- Jessica M Schwartzman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, 3250 Wilshire Blvd, Los Angeles, CA, 90010, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Andrew E Molnar
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA
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Conner K, Gandy M, Munger-Clary HM. What is the role of screening instruments in the management of psychiatric comorbidities in epilepsy? Tools and practical tips for the most common comorbidities: Depression and anxiety. Epilepsy Behav Rep 2024; 25:100654. [PMID: 38389991 PMCID: PMC10881315 DOI: 10.1016/j.ebr.2024.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Depression and anxiety are the most common psychiatric comorbidities in epilepsy and are known to increase healthcare utilization, the risk of refractory epilepsy, and anti-seizure medication intolerability. Despite this, depression and anxiety continue to be underrecognized and undertreated in people with epilepsy (PWE). Several barriers to the identification of depression and anxiety in PWE exist, including reliance on unstructured interviews rather than standardized, validated instruments. Moreover, there is a dearth of behavioral health providers to manage these comorbidities once identified. The use of validated screening instruments in epilepsy clinics can assist with both the identification of psychiatric symptoms and monitoring of treatment response by the epilepsy clinician for PWE with comorbid depression and/or anxiety. While screening instruments can identify psychiatric symptoms occurring within a specified time, they are not definitively diagnostic. Screeners can be time efficient tools to identify patients requiring further evaluation for diagnostic confirmation. This article reviews recent literature on the utility of depression and anxiety screening instruments in epilepsy care, including commonly used screening instruments, and provides solutions for potential barriers to clinical implementation. Validated depression and anxiety screening instruments can increase identification of depression and anxiety and guide epilepsy clinician management of these comorbidities which has the potential to positively impact patient care.
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Affiliation(s)
- Kelly Conner
- Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Milena Gandy
- The School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Heidi M Munger-Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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3
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Russell EA, Bennett SD, Ali R, Baron S, Flohr C, Grindlay D, Heyman I, McPherson T, Ravenscroft JC. Identifying mental health needs of children and youth with skin disease: A systematic review of screening and assessment tools. Pediatr Dermatol 2022; 39:541-546. [PMID: 35416327 DOI: 10.1111/pde.14991] [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: 11/24/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES (1) To identify patient reported outcome measures (PROMs) which have been used to screen and assess mental health symptoms in studies of youth with skin disease. (2) To critically appraise their evidence base in this population. METHODS A systematic literature search was conducted within PubMed and PsycINFO combining search terms for pediatric populations, dermatology, screening and assessment tools, and psychological and psychiatric conditions, to identify PROMs which screened or assessed for mental health symptoms in youth with skin disease. PROMs which had undergone validation within this population were assessed for quality and evidence base using the COSMIN risk of bias tool. RESULTS One hundred eleven PROMs which assess mental health symptoms in studies of youth with skin disease were identified. These included generic mental health scales which are extensively validated in different populations. Only one PROM, the "Skin Picking Scale-Revised" has undergone specific validation in youth with skin disease. This showed poor quality of evidence for content validity and therefore cannot be recommended. CONCLUSION There is an urgent need to identify mental health problems early and treat proactively to improve outcomes in youth with skin disease. This review highlights the current lack of consensus around the best way to assess our patients. It is likely that existing generic mental health methods and PROMS will be appropriate for our needs. More work is required to examine the utility, feasibility, and acceptability of existing generic, validated mental health screening tools in youth with skin disease.
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Affiliation(s)
| | | | | | | | | | - Douglas Grindlay
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children, London, UK
| | | | - Jane C Ravenscroft
- Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
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Aydin S, Siebelink BM, Crone MR, van Ginkel JR, Numans ME, Vermeiren RRJM, Michiel Westenberg P. The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment. BJPsych Open 2022; 8:e81. [PMID: 35388780 PMCID: PMC9059622 DOI: 10.1192/bjo.2022.47] [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: 08/30/2021] [Revised: 02/08/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A variety of information sources are used in the best-evidence diagnostic procedure in child and adolescent mental healthcare, including evaluation by referrers and structured assessment questionnaires for parents. However, the incremental value of these information sources is still poorly examined. AIMS To quantify the added and unique predictive value of referral letters, screening, multi-informant assessment and clinicians' remote evaluations in predicting mental health disorders. METHOD Routine medical record data on 1259 referred children and adolescents were retrospectively extracted. Their referral letters, responses to the Strengths and Difficulties Questionnaire (SDQ), results on closed-ended questions from the Development and Well-Being Assessment (DAWBA) and its clinician-rated version were linked to classifications made after face-to-face intake in psychiatry. Following multiple imputations of missing data, logistic regression analyses were performed with the above four nodes of assessment as predictors and the five childhood disorders common in mental healthcare (anxiety, depression, autism spectrum disorders, attention-deficit hyperactivity disorder, behavioural disorders) as outcomes. Likelihood ratio tests and diagnostic odds ratios were computed. RESULTS Each assessment tool significantly predicted the classified outcome. Successive addition of the assessment instruments improved the prediction models, with the exception of behavioural disorder prediction by the clinician-rated DAWBA. With the exception of the SDQ for depressive and behavioural disorders, all instruments showed unique predictive value. CONCLUSIONS Structured acquisition and integrated use of diverse sources of information supports evidence-based diagnosis in clinical practice. The clinical value of structured assessment at the primary-secondary care interface should now be quantified in prospective studies.
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Affiliation(s)
- Semiha Aydin
- Department of Developmental and Educational Psychology, Leiden University, The Netherlands; Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, The Netherlands; and Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands
| | - Bart M. Siebelink
- Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, The Netherlands
| | - Matty R. Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands
| | - Joost R. van Ginkel
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, The Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands
| | - Robert R. J. M. Vermeiren
- Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, The Netherlands; and Youz, Parnassia Group, The Netherlands
| | - P. Michiel Westenberg
- Department of Developmental and Educational Psychology, Leiden University, The Netherlands
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Bennett SD, Heyman I, Coughtrey AE, Varadkar S, Stephenson T, Shafran R. Telephone-guided self-help for mental health difficulties in neurological conditions: a randomised pilot trial. Arch Dis Child 2021; 106:862-867. [PMID: 33402326 DOI: 10.1136/archdischild-2019-318577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions. DESIGN Preliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire. SETTING Neurology clinics in a national tertiary paediatric hospital. PATIENTS Young people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment. INTERVENTIONS 12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14). RESULTS 124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable. CONCLUSIONS Further feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended. TRIAL REGISTRATION NUMBER ISRCTN21184717.
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Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
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George C, Felix SA, McLellan A, Shetty J, Middleton J, Chin RF, Poveda B, Brand C, Small M, Verity K. Pilot project of psychological services integrated into a pediatric epilepsy clinic: Psychology Adding Value - Epilepsy Screening (PAVES). Epilepsy Behav 2021; 120:107968. [PMID: 33971391 DOI: 10.1016/j.yebeh.2021.107968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
RATIONALE Children and young people with epilepsy (CYPwE) are particularly vulnerable to developing social, emotional, behavioral, and learning difficulties, which, if not identified or addressed at an early stage, can impact adversely on quality of life and long-term psychosocial outcomes. This paper describes the development of a screening protocol and a pathway of early, 'stepped' intervention, which aims to address this issue, together with initial outcomes. METHODS The Strengths and Difficulties Questionnaire (SDQ) was completed by CYPwE and their parents prior to routine epilepsy clinic appointments. A traffic light system was devised to indicate the reported level of concern and a potential route through the early intervention pathway. RESULTS Of those CYPwE screened, 53% were found to be experiencing elevated levels of mental health difficulties, which had not previously been identified, and had the opportunity to access an appropriate early intervention. Initial feedback on the PAVES pathway has been positive, with high levels of feasibility and acceptability indicated by young people, parents, and clinicians. CONCLUSIONS The PAVES approach enables mental health difficulties to be identified and appropriate intervention accessed at an early stage, potentially improving long-term psychosocial outcomes for CYPwE. In addition, if found to be effective in larger trials, PAVES has potential to be adapted and generalized to other populations.
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Affiliation(s)
- Catriona George
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Suzanne A Felix
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Ailsa McLellan
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Jay Shetty
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Jack Middleton
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Richard F Chin
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Blanca Poveda
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Celia Brand
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Michelle Small
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Kirsten Verity
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
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Batchelor R, Taylor MD. Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality. Epilepsy Behav 2021; 118:107911. [PMID: 33773441 DOI: 10.1016/j.yebeh.2021.107911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND People with epilepsy (PWE) are at an increased risk of anxiety, depression, and suicidality. Young adulthood is a critical developmental period which can be complicated by the unique challenges of having epilepsy. The risk factors of mental health difficulties in young adults with epilepsy (YAWE) have not been investigated. AIMS To examine the relationships between psychosocial variables (coping strategies and sources of social support) and mental health outcomes in YAWE, and determine whether these psychosocial variables independently predict mental health outcomes after controlling for sociodemographic and epilepsy-related factors. METHOD An online survey was completed by 144 YAWE (18-25-year-olds), which measured sociodemographic and epilepsy-related factors, coping strategies, sources of social support, and current mental health symptoms (anxiety, depression, and suicidality). RESULTS Avoidant-focused coping was positively correlated, and problem-focused coping and meaning-focused coping were negatively correlated, with symptoms of anxiety, depression, and suicidality. Social support from family, friends, and a special person all negatively correlated with mental health outcomes. Using multiple regression analyses, greater use of avoidant-focused coping strategies independently predicted higher symptoms of anxiety, depression, and suicidality. Greater support from friends independently predicted significantly lower anxiety and depression, whereas greater support from family independently predicted significantly lower suicidality. CLINICAL IMPLICATIONS These findings have implications for clinical practice in YAWE and suggest that screening for mental health symptoms and psychosocial variables to identify those at risk would be beneficial. Access to tailored psychological support is also needed.
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Affiliation(s)
| | - Michelle D Taylor
- Royal Holloway, University of London, Surrey, UK; Health Psychology Research Limited (HPR Ltd.), 188 Egham High Street, Surrey, UK
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8
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Bennett SD, Au C, Byford S, Chorpita B, Coughtrey AE, Cross JH, Dalrymple E, Fonagy P, Ford T, Heyman I, Lewins A, Moss-Morris R, Reilly C, Xu L, Shafran R. Feasibility of telephone-delivered therapy for common mental health difficulties embedded in pediatric epilepsy clinics. Epilepsy Behav 2021; 116:107743. [PMID: 33556861 DOI: 10.1016/j.yebeh.2020.107743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. OBJECTIVE To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. METHODS Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. RESULTS All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen's d = 0.62), total impact of mental health problems (p = 0.03; Cohen's d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen's d = 0.57) and quality of life (p = 0.01; Cohen's d = 0.57). CONCLUSION A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.
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Affiliation(s)
- Sophie D Bennett
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK.
| | - Christy Au
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Sarah Byford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Bruce Chorpita
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Anna E Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - J Helen Cross
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Emma Dalrymple
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Peter Fonagy
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Tamsin Ford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Amy Lewins
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rona Moss-Morris
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Colin Reilly
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Laila Xu
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Roz Shafran
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
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Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
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Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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10
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Healy SA, Fantaneanu TA, Whiting S. The Importance of Assessing and Treating Mental Health in Transition-Aged Adolescents with Epilepsy: A 1-Year Follow-up. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractMental health issues become especially problematic when adolescents with epilepsy are preparing to transition from pediatric to adult care. Consistent with guidelines, a transition clinic with ongoing mental health assessment was created, providing treatment to patients scoring in the moderate severity range or higher. In order to examine the effectiveness of our epilepsy transition clinic and the impact of mental health in transition-aged adolescents, baseline and one-year follow-up data were compared in 36 participants (M = 15.82 years, 24 males). Results showed that the majority of participants had improved or comparable mental health scores at follow-up. Furthermore, participants who met threshold for mental health treatment had significantly improved mental health (t = 3.19, p = 0.015), while those who did not showed worsened mental health (t = − 2.50, p = 0.019). Looking specifically at mental health impact, those with worsened mental health showed significantly worsened quality of life (t = 3.35, p = 0.012). Furthermore, those without mental health issues showed improved transition skills (t = − 3.86, p = 0.002), while those with mental health issues did not. Results suggest that the transition clinic is effective in helping transition-aged adolescents with their mental health. Additionally, findings suggest that addressing these mental health issues are essential to ensuring successful transitions and the best outcomes in these patients.
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Affiliation(s)
- Sarah A. Healy
- Division of Neurology, The Children's Hospital of Eastern Ontario, Ontario, Canada
| | | | - Sharon Whiting
- Division of Neurology, The Children's Hospital of Eastern Ontario, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Canada
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11
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Welch A, Shafran R, Heyman I, Coughtrey A, Bennett S. Usual care for mental health problems in children with epilepsy: A cohort study. F1000Res 2018; 7:1907. [PMID: 32494354 PMCID: PMC7233177 DOI: 10.12688/f1000research.15492.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Epilepsy is one of the most common chronic paediatric conditions. Children and young people with epilepsy are at a significantly higher risk of developing mental health problems relative to the general population, yet the majority of these problems are unrecognised and under-treated in clinical practice. Although there is little epilepsy-specific guidance as to what interventions to use, researchers suggest there is no reason why clinicians should not be using the evidence base. Given the poor prognosis of untreated mental health difficulties, this cohort study sought to identify what psychological treatment young people with epilepsy with mental health needs receive in routine practice. Methods: Participants were children and young people aged 3 to 18 attending paediatric neurology clinics. The parents of those children who met threshold for impairing symptoms on the Strengths and Difficulties questionnaire were asked to complete the Development and Well-being Assessment (DAWBA), an online clinical assessment designed to generate psychiatric diagnoses. Participants who met clinical threshold for a disorder according to the DAWBA were provided with a bespoke measure asking questions regarding their experience with treatment for mental health support. Results: 16 of the 46 parents who completed the DAWBA reported that they had experienced previous or current support for their child's mental health difficulties. The mental health support offered to families was highly variable, inadequate and often not clearly compliant with existing UK National Institute for Health and Clinical Excellence (NICE) guidelines for mental health treatment in children and young people. Conclusions: The present study demonstrates the inconsistency and inadequacy of mental health provision for children and young people with epilepsy. Future work should explore reasons for the treatments offered failing to adhere to existing guidance for mental health difficulties in children, as well as possible solutions to this.
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Affiliation(s)
- Alice Welch
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Isobel Heyman
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anna Coughtrey
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sophie Bennett
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Welch A, Shafran R, Heyman I, Coughtrey A, Bennett S. Usual care for mental health problems in children with epilepsy: A cohort study. F1000Res 2018; 7:1907. [PMID: 32494354 PMCID: PMC7233177 DOI: 10.12688/f1000research.15492.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Epilepsy is one of the most common chronic paediatric conditions. Children and young people with epilepsy are at a significantly higher risk of developing mental health problems relative to the general population, yet the majority of these problems are unrecognised and under-treated in clinical practice. Although there is little epilepsy-specific guidance as to what interventions to use, researchers suggest there is no reason why clinicians should not be using the evidence base. Given the poor prognosis of untreated mental health difficulties, this cohort study sought to identify what psychological treatment young people with epilepsy with mental health needs receive in routine practice. Methods: Participants were children and young people aged 3 to 18 attending paediatric neurology clinics. The parents of those children who met threshold for impairing symptoms on the Strengths and Difficulties questionnaire were asked to complete the Development and Well-being Assessment (DAWBA), an online clinical assessment designed to generate psychiatric diagnoses. Participants who met clinical threshold for a disorder according to the DAWBA were provided with a bespoke measure asking questions regarding their experience with treatment for mental health support. Results: 16 of the 46 parents who completed the DAWBA reported that they had experienced previous or current support for their child's mental health difficulties. The mental health support offered to families was highly variable, inadequate and often not clearly compliant with existing UK National Institute for Health and Clinical Excellence (NICE) guidelines for mental health treatment in children and young people. Conclusions: The present study demonstrates the inconsistency and inadequacy of mental health provision for children and young people with epilepsy. Future work should explore reasons for the treatments offered failing to adhere to existing guidance for mental health difficulties in children, as well as possible solutions to this.
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Affiliation(s)
- Alice Welch
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Isobel Heyman
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anna Coughtrey
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sophie Bennett
- Great Ormond Street Institute of Child Health, University College London, London, UK
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