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Leyenaar JK, Arakelyan M, Schaefer AP, Freyleue SD, Austin AM, Simon TD, Van Cleave J, Ahuja N, Chien AT, Moen EL, O’Malley AJ, Goodman DC. Neurodevelopmental and Mental Health Conditions in Children With Medical Complexity. Pediatrics 2024; 154:e2024065650. [PMID: 39099441 PMCID: PMC11350095 DOI: 10.1542/peds.2024-065650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with medical complexity (CMC) may be at a high risk of neurodevelopmental and mental health conditions given disease comorbidities and lived experiences. Little is known about the prevalence of these conditions at a population level. In this study, we estimated the prevalence of neurodevelopmental and mental health diagnoses in CMC relative to children without medical complexity and measured associations between these diagnoses in CMC and subsequent health care utilization and in-hospital mortality. METHODS We applied the Child and Adolescent Mental Health Disorders Classification System to identify neurodevelopmental and mental health diagnoses using all-payer claims data from three states (2012-2017). Poisson regression was used to compare outcomes in CMC with neurodevelopmental and mental health diagnoses to CMC without these diagnoses, adjusting for sociodemographic and clinical characteristics. RESULTS Among 85 581 CMC, 39 065 (45.6%) had ≥1 neurodevelopmental diagnoses, and 31 703 (37.0%) had ≥1 mental health diagnoses, reflecting adjusted relative risks of 3.46 (3.42-3.50) for neurodevelopmental diagnoses and 2.22 (2.19-2.24) for mental health diagnoses compared with children without medical complexity. CMC with both neurodevelopmental and mental health diagnoses had 3.00 (95% confidence interval [CI]: 2.98-3.01) times the number of ambulatory visits, 69% more emergency department visits (rate ratio = 1.69, 95% CI: 1.66-1.72), 58% greater risk of hospitalization (rate ratio = 1.58, 95% CI: 1.50-1.67), and 2.32 times (95% CI: 2.28-2.36) the number of hospital days than CMC without these diagnoses. CONCLUSIONS Neurodevelopmental and mental health diagnoses are prevalent among CMC and associated with increased health care utilization across the continuum of care. These findings illustrate the importance of recognizing and treating neurodevelopmental and mental health conditions in this population.
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Affiliation(s)
- JoAnna K. Leyenaar
- Department of Pediatrics, Children’s Hospital at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice
| | - Mary Arakelyan
- Department of Pediatrics, Children’s Hospital at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | - Tamara D. Simon
- Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jeanne Van Cleave
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Namrata Ahuja
- Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Alyna T. Chien
- Boston Children’s Hospital, Boston, Masssachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erika L. Moen
- The Dartmouth Institute for Health Policy & Clinical Practice
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - David C. Goodman
- Department of Pediatrics, Children’s Hospital at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice
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Geweniger A, Barth M, Haddad A, Högl H, Insan S, Mund A, Langer T. Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic. Front Public Health 2024; 12:1322185. [PMID: 38487183 PMCID: PMC10937572 DOI: 10.3389/fpubh.2024.1322185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Background Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES. Methods This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES. Results The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age. Conclusion The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.
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Affiliation(s)
- Anne Geweniger
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Michael Barth
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Anneke Haddad
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Shrabon Insan
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
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Cañizares M, Unnerstall A, Graaf G. COVID-19 Modifications in Public Home- and Community-Based Services for Children with Mental Health Needs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:85-102. [PMID: 37976019 PMCID: PMC10962056 DOI: 10.1007/s10488-023-01315-5] [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: 10/12/2023] [Indexed: 11/19/2023]
Abstract
Eleven states offer 1915(c) Home and Community Based Services (HCBS) Medicaid waivers to organize and fund programs that provide in-home and community support services to address the unique needs of children and youth with complex mental health concerns and their families. However, as the COVID-19 pandemic-imposed restrictions on community movement and school engagement were enacted, these children and youth lost in-person access to needed supports through school-based programs and professional community providers. The well documented mental health impacts of the pandemic on children and youth necessitates understanding how behavioral health programs and policies were adapted to the constraints of pandemic life for this uniquely at-risk population. This study examines and characterizes trends in modifications made to these programs. Appendix K applications amending HCBS waiver programs targeting children with serious emotional disturbances (SED) were collected from the Center for Medicaid & Medicare Services (CMS) website. In total, 33 applications from 10 states were included in the study. Utilizing a policy mapping approach, applications were coded by hand comparing text from elements in the applications across all 10 states. A summary of program changes reported in applications was created and changes were tracked over the course of the federal public health emergency. States modified programs by adding services for waiver participants, changing the service settings allowed, removing service limit restrictions, and offering electronic/remote service delivery. All states also issued measures to either expand or retain their provider workforce, adding family members as providers, modifying experience requirements, and offering financial incentives via increased payment rates or retainer payments. Modifications to mental health assessment processes ranged from changing the evaluation tools or documentation requirements, extending deadlines, and allowing for remote evaluations. Service plan development processes were adapted by allowing virtual service plan development meetings, allowing participants or representatives to electronically sign plans of care, and permitting verbal consent to begin receiving services. Documenting programmatic adjustments provides a context for further research to understand the experiences of youth, families, and providers in navigating these changes and the relative success or failures of these policies.
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Affiliation(s)
- Monica Cañizares
- School of Social Work, The University of Texas at Arlington, 501 W. Mitchell Street, Box 19129, Arlington, TX, 76019, USA
| | - Anna Unnerstall
- School of Social Work, The University of Texas at Arlington, 501 W. Mitchell Street, Box 19129, Arlington, TX, 76019, USA
| | - Genevieve Graaf
- School of Social Work, The University of Texas at Arlington, 501 W. Mitchell Street, Box 19129, Arlington, TX, 76019, USA.
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Barbieri V, Piccoliori G, Mahlknecht A, Plagg B, Ausserhofer D, Engl A, Wiedermann CJ. Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy. Behav Sci (Basel) 2023; 13:643. [PMID: 37622783 PMCID: PMC10451173 DOI: 10.3390/bs13080643] [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: 07/12/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the mental health and well-being of adolescents. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health among adolescents in Northern Italy by comparing cross-sectional surveys conducted in 2021 and 2022, with a particular focus on the influence of age and gender. The sample included adolescents aged 11-19 years from public schools in South Tyrol. Validated psychometric instruments were used to assess HRQoL, anxiety and depression symptoms, and psychosomatic complaints. Sociodemographic variables, COVID-19 burden, and pandemic-related factors were measured. Statistical analyses included chi-square tests, correlation coefficients, and logistic regression analyses. The results indicated that while the self-reported burden of adolescents decreased significantly in 2022 (n = 1885) compared to 2021 (n = 1760), there were no significant differences in symptoms of anxiety, depressive symptoms, low HRQoL, and increased psychosomatic complaints between the two surveys for both early and late adolescents. Females consistently had higher percentages for all outcome variables, and symptoms of anxiety increased with age in females, but not in males. Both genders experienced an increase in depressive symptoms and low HRQoL with age. The co-occurrence of mental health outcomes was observed, suggesting overlapping patterns among anxiety, depression, low HRQoL, and psychosomatic complaints. These findings underscore the intricate relationship between age, gender, and mental health outcomes among adolescents during the pandemic. It is important to recognize that late adolescents may exhibit distinct vulnerabilities and may require tailored support approaches to address their specific mental health challenges, differing from those needed for early adolescents.
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Affiliation(s)
- Verena Barbieri
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Dietmar Ausserhofer
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology—Tyrol, 6060 Hall, Austria
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Barbieri V, Wiedermann CJ, Piccoliori G, Mahlknecht A, Plagg B, Ausserhofer D, Ravens-Sieberer U, Engl A. Evolution of Youth's Mental Health and Quality of Life during the COVID-19 Pandemic in South Tyrol, Italy: Comparison of Two Representative Surveys. CHILDREN (BASEL, SWITZERLAND) 2023; 10:895. [PMID: 37238443 PMCID: PMC10217242 DOI: 10.3390/children10050895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has led to an increase in youth mental health problems worldwide. Studies have revealed substantial variation in the incidence of these problems across different regions. Longitudinal studies of children and adolescents in Italy are lacking. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health in Northern Italy by comparing surveys conducted in June 2021 and in March 2022. METHODS A representative, large cross-sectional, online survey investigated HRQoL, psychosomatic complaints, and symptoms of anxiety and depression among 5159 and 6675 children and adolescents in 2021 and 2022, respectively, using the KIDSCREEN-10 index, HBSC symptom checklist, SCARED, CES-DC, and PHQ-2 instruments. Statistical analyses included a multivariate linear regression analysis. RESULTS Baseline characteristics showed significant differences in demographic variables between the two surveys. Girls and their parents reported a significantly lower HRQoL in 2021 than in 2022. Psychosomatic complaints differed significantly between sexes, and the results showed no decrease in psychosomatic complaints, anxiety, or depression between 2021 and 2022. Predictors of HRQoL, anxiety, depressive symptoms, and psychosomatic complaints in 2022 differed from those in 2021. CONCLUSIONS The characteristics of the 2021 pandemic, including lockdowns and home schooling, may have contributed to the differences between the two surveys. As most pandemic restrictions ended in 2022, the results confirm the need for measures to improve the mental and physical health of children and adolescents after the pandemic.
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Affiliation(s)
- Verena Barbieri
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Dietmar Ausserhofer
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
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Da Costa IGR, Brugnaro BH, Lima CRG, Kraus de Camargo O, Fumincelli L, Pavão SL, Rocha NACF. Perceived Social Support and Quality of Life of Children with and without Developmental Disabilities and Their Caregivers during the COVID-19 Pandemic in Brazil: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4449. [PMID: 36901463 PMCID: PMC10001514 DOI: 10.3390/ijerph20054449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Social support and Quality of life (QoL) are important aspects of life and should be explored during the specific scenario of the pandemic. AIMS (i) to compare the perceived social support (PSS) in caregivers and the domains of QoL of the caregiver and the child with developmental disabilities (DD) and typical development (TD); (ii) to verify the existence of the association, in each group, between the PSS, and the domain of QoL of the caregiver and the child. METHODS AND PROCEDURES 52 caregivers of children with DD and 34 with TD participated remotely. We assessed PSS (Social Support Scale), children's QoL (PedsQL-4.0-parent proxy) and caregivers' QoL (PedsQL-Family Impact Module). The groups were compared for the outcomes using the Mann-Whitney test, and Spearman's test evaluated the correlation between the PSS and the QoL (child and caregiver) in each of the groups. OUTCOMES AND RESULTS There was no difference between groups for PSS. Children with DD presented lower values in PedsQL total, psychosocial health, physical health, social activities, and school activity. Caregivers of children with TD presented lower values in PedsQL family total, physical capacity, emotional aspect, social aspect, daily activities, and higher value in communication. In the DD group, we found a positive relationship between PSS with child: Psychosocial Health (r = 0.350) and Emotional Aspect (r = 0.380), and with family: Total (r = 0.562), Physical Capacity (r = 0.402), Emotional Aspect (r = 0.492), Social Aspect (r = 0.606), Communication (r = 0.535), Concern (r = 0.303), Daily Activities (r = 0.394) and Family Relationships (r = 0.369). In the TD group, we found that PSS was positively associated with Family: Social Aspect (r = 0.472) and Communication (r = 0.431). CONCLUSIONS AND IMPLICATIONS During the COVID-19 pandemic, despite both groups presenting similar PSS, there are important differences in QoL between them. For both groups, greater levels of perceived social support are associated with greater caregiver-reported in some domains of the child's and caregiver's QoL. These associations are more numerous, especially for the families of children with DD. This study provides a unique view into the relationships between perceived social support and QoL during the "natural experiment" of living through a pandemic.
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Affiliation(s)
- Isabelle Gansella Rocha Da Costa
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Beatriz Helena Brugnaro
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Camila Resende Gâmbaro Lima
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Olaf Kraus de Camargo
- CanChild, Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Lais Fumincelli
- Department of Nursing, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Silvia Letícia Pavão
- Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná (UFPR), Curitiba 80060-000, PR, Brazil
| | - Nelci Adriana Cicuto Ferreira Rocha
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
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