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Stewart SL, Semovski V, Lapshina N. Adolescent Inpatient Mental Health Admissions: An Exploration of Interpersonal Polyvictimization, Family Dysfunction, Self-Harm and Suicidal Behaviours. Child Psychiatry Hum Dev 2024; 55:963-974. [PMID: 36315373 PMCID: PMC11245427 DOI: 10.1007/s10578-022-01450-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
The mental health system is impacted by extreme delays in the provision of care, even in the face of suicidal behaviour. The failure to address mental health issues in a timely fashion result in a dependence on acute mental health services. Improvement to the mental health care system is impacted by the paucity of information surrounding client profiles admitted to inpatient settings. Using archival data from 10,865 adolescents 12-18 years of age (Mage = 14.87, SDage = 1.77), this study aimed to examine the characteristics of adolescents admitted to psychiatric inpatient services in Ontario, Canada. Multivariate binary logistic regression revealed that adolescents reporting interpersonal polyvictimization, greater family dysfunction and higher risk of suicide and self-harm had a greater likelihood of an inpatient mental health admission. The interRAI Child and Youth Mental Health assessment can be used for care planning and early intervention to support adolescents and their families before suicide risk is imminent.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada
| | - Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada.
| | - Natalia Lapshina
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada
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Semovski V, King CB, Stewart SL. Mental Health Service Urgency in Children's Mental Health: Factors Impacting the Need for Expedited Services. Child Psychiatry Hum Dev 2022; 53:765-775. [PMID: 33835279 DOI: 10.1007/s10578-021-01161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.
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Affiliation(s)
- Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada.
| | - Colin B King
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
| | - Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
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Posserud MB, Skretting Solberg B, Engeland A, Haavik J, Klungsøyr K. Male to female ratios in autism spectrum disorders by age, intellectual disability and attention-deficit/hyperactivity disorder. Acta Psychiatr Scand 2021; 144:635-646. [PMID: 34494265 DOI: 10.1111/acps.13368] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the gender distribution in ASD in adults compared with children and the impact of comorbid intellectual disability (ID) and attention-deficit/hyperactivity disorder (ADHD) on the male to female ratio (MFR). METHODS We estimated the MFR and the male prevalence ratio (PR) for ASD in adults and children using the Medical Birth Registry of Norway, including all individuals born during 1967-2011. We examined variation with age, comorbid ID and ADHD as defined by diagnoses in the Norwegian Patient Registry during 2008-2015 and/or a dispensed prescription for ADHD medication. RESULTS The sample included 1,701,206 adults and 804,146 children, including 8,995 (0.5%) adults and 8,056 (1.0%) children with ASD, 53,822 (3.2%) adults and 26,967 (3.4%) children with ADHD and 9,178 (0.5%) adults and 5,038 (0.6%) children with ID. The MFR for ASD was 3.67 in children and 2.57 in adults, corresponding to a male PR in ASD of 1.54 (95% CI 1.53-1.56) and 1.41 (1.39-1.24), respectively. Comorbid ID decreased the MFR and the male PR in both adults and children, whereas comorbid ADHD significantly increased the male PR in children. The MFR and the population prevalence of ASD, ADHD and ID decreased from children to younger adults and yet further to older adults. CONCLUSION We found a lower MFR and male PR in adults than in children. Findings suggest the strong male predominance seen in childhood/clinical studies of ASD diminishes in adult samples, possibly reflecting the influence of non-aetiological factors such as later diagnosis in females, diagnostic biases and diagnostic trends.
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Affiliation(s)
- Maj-Britt Posserud
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Berit Skretting Solberg
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Child and Adolescent Psychiatric Outpatient Unit, Hospital Betanien, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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Marshall C, Semovski V, Stewart SL. Exposure to childhood interpersonal trauma and mental health service urgency. CHILD ABUSE & NEGLECT 2020; 106:104464. [PMID: 32497938 DOI: 10.1016/j.chiabu.2020.104464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children and youth with a history of maltreatment experience different developmental, psychiatric and health problems. Ensuring there is streamlined access to services is imperative to recovery. Yet, few reports of standardized methods for directing and prioritizing risk for children seeking services exist. OBJECTIVE The current study aims to address this gap and explore how mental health personnel triage highly vulnerable cases. Specifically, the goal of the current study is to examine whether experiencing childhood interpersonal trauma predicts service urgency. PARTICIPANTS AND SETTING Participants were 19,645 children and youth, ages 4-18 years (M = 11.1 SD = 3.4) who completed the interRAI Child and Youth Mental Health Screener (ChYMH-S) at various community-based and residential children's mental health facilities across Ontario. METHODS Retrospective data collected from the ChYMH-S was used to explore differences in maltreatment history, gender, and legal guardianship and their impact on service prioritization. RESULTS Children and youth who were exposed to some form of interpersonal trauma were more likely to have mental health issues requiring urgent follow-up service compared to those who were not exposed. Findings also suggested that gender and legal guardianship impact service urgency. CONCLUSIONS Children and youth who have experienced maltreatment are significantly more likely to score high on mental health service urgency than those who did not. This provides valuable insight that can support the development of appropriate system-level changes to policy and practice when servicing children and youth with mental health needs in Canada.
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Affiliation(s)
- Catherine Marshall
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada
| | - Valbona Semovski
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada.
| | - Shannon L Stewart
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada
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Longitudinal Determinants of School-Based Mental Health Service Use for Girls and Boys with Externalizing Behavior Problems. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9249-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abbas S, Ihle P, Adler JB, Engel S, Günster C, Holtmann M, Kortevoss A, Linder R, Maier W, Lehmkuhl G, Schubert I. Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders. Eur Child Adolesc Psychiatry 2017; 26:433-444. [PMID: 27628527 DOI: 10.1007/s00787-016-0900-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.
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Affiliation(s)
- Sascha Abbas
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | - Peter Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | | | - Susanne Engel
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | | | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Axel Kortevoss
- GeoMed Research Forschungsgesellschaft mbH, Bad Honnef, Germany
| | - Roland Linder
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Werner Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Gerd Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
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The longitudinal BELLA study: design, methods and first results on the course of mental health problems. Eur Child Adolesc Psychiatry 2015; 24:651-63. [PMID: 25428179 DOI: 10.1007/s00787-014-0638-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
The high prevalence of mental health problems (MHP) in childhood and adolescence is a global health challenge of the 21st century. Information about age of onset, persistence and development of MHP in young people is necessary to implement effective prevention and intervention strategies. We describe the design and methods of the longitudinal BELLA study, which investigates developmental trajectories of MHP from childhood into adulthood, their determinants, and the utilisation of mental health services. First results on the developmental course of MHP in children and adolescents are reported over a 6-year period. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KiGGS). BELLA examines the mental health and well-being of children and adolescents aged 7-17 years (a representative subsample of KiGGS, n = 2,863 at baseline). Standardised screening measures served to identify MHP at baseline and at follow-ups (1, 2, and 6 years later). Among children and adolescents participating at all measurement points (n = 1,255), 10 % showed clinically significant MHP at baseline (n = 130). Over the 6-year period, 74.3 % showed no signs of MHP (n = 933), 15.5 % had remitted (n = 194), 2.9 % showed persistent (n = 36) and 7.3 % acute or recurrent MHP (n = 92). Overall, MHP were more likely to occur between the age of 7 and 12 and after the age of 19 years. Regarding mental health service use, 33 % of the participants with acute or recurrent MHP (n = 30) and 63.9 % with persistent MHP used mental health services (n = 23). Mental health problems in children and adolescents have a high risk to persist into adulthood. In children and adolescents a low rate of mental health service use was observed, even among those with mental health problems.
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Bevaart F, Mieloo CL, Wierdsma A, Donker MCH, Jansen W, Raat H, Verhulst FC, van Oort FVA. Ethnicity, socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour. Soc Psychiatry Psychiatr Epidemiol 2014; 49:733-42. [PMID: 24077635 DOI: 10.1007/s00127-013-0761-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Empirical research on mental health care use and its determinants in young school-aged children is still scarce. In this study, we investigated the role of ethnicity, socioeconomic position (SEP) and perceived severity by both parents and teachers on mental health care use in 5- to 8-year old children with emotional and/or behavioural problems. METHODS Data from 1,269 children with a high score([P90) on the Strengths and Difficulties Questionnaire (SDQ) in the school year 2008–2009 were linked to psychiatric case register data over the years 2010–2011. Cox proportional hazards models were used to predict mental health care use from ethnicity, SEP and perceived severity of the child's problems. RESULTS During the follow-up period, 117 children with high SDQ scores (9.2 %) had used mental health care for the first time. Ethnic minority children were less likely to receive care than Dutch children (HR Moroccan/Turkish:0.26; 95 % CI 0.13-0.54, HR other ethnicity: 0.26; 95 %CI 0.12-0.58). No socioeconomic differences were found.After correction for previous care use, ethnicity and parental perceived severity, impact score as reported by teachers was significantly associated with mental healthcare use (HR 1.58; 95 % CI 1.01–2.46). CONCLUSIONS Ethnicity is an important predictor of mental health care use in young children. Already in the youngest school-aged children, ethnic differences in the use of mental health care are present.A distinct predictor of care use in this age group is severity of emotional and behavioural problems as perceived by teachers. Therefore, teachers may be especially helpful in the process of identifying young children who need specialist mental health care.
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Helland WA, Lundervold AJ, Heimann M, Posserud MB. Stable associations between behavioral problems and language impairments across childhood - the importance of pragmatic language problems. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:943-951. [PMID: 24642228 DOI: 10.1016/j.ridd.2014.02.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/18/2014] [Accepted: 02/21/2014] [Indexed: 06/03/2023]
Abstract
This study investigated language function associated with behavior problems, focusing on pragmatics. Scores on the Children's Communication Checklist Second Edition (CCC-2) in a group of 40 adolescents (12-15 years) identified with externalizing behavior problems (BP) in childhood was compared to the CCC-2 scores in a typically developing comparison group (n=37). Behavioral, emotional and language problems were assessed by the Strengths and Difficulties Questionnaire (SDQ) and 4 language items, when the children in the BP group were 7-9 years (T1). They were then assessed with the SDQ and the CCC-2 when they were 12-15 years (T2). The BP group obtained poorer scores on 9/10 subscales on the CCC-2, and 70% showed language impairments in the clinical range. Language, emotional and peer problems at T1 were strongly correlated with pragmatic language impairments in adolescence. The findings indicate that assessment of language, especially pragmatics, is vital for follow-up and treatment of behavioral problems in children and adolescents.
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Affiliation(s)
- Wenche Andersen Helland
- Department of Psychiatry, Helse Fonna HF, Stord Hospital, 5414 Stord, Norway; Department of Biological and Medical Psychology, University of Bergen, P.O. Box 7800, 5020 Bergen, Norway; Department of Speech and Language Disorders, Statped vest, P.O. Box 6039, 5892 Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, P.O. Box 7800, 5020 Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health; Uni Research, P. O. Box 7800, 5032 Bergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Norway
| | - Mikael Heimann
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden; The Swedish Institute of Disability Research, Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Maj-Britt Posserud
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health; Uni Research, P. O. Box 7800, 5032 Bergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Norway
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Paula CS, Bordin IAS, Mari JJ, Velasque L, Rohde LA, Coutinho ESF. The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions. PLoS One 2014; 9:e88241. [PMID: 24558382 PMCID: PMC3928169 DOI: 10.1371/journal.pone.0088241] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. Objectives To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU. Methods Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES). Results Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems. Conclusions Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care.
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Affiliation(s)
- Cristiane S. Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, São Paulo, Brasil
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
- * E-mail:
| | - Isabel A. S. Bordin
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
| | - Jair Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
| | - Luciane Velasque
- Departamento de Matemática de Estatística. Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luis A. Rohde
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Evandro S. F. Coutinho
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Escola Nacional de Saúde Pública-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brasil
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