Complementary and alternative medicine use among children with mental health issues: results from the National Health Interview Survey

Cross-Cultural Patient Counseling and Communication in the Integrative Medicine Setting: Respecting the Patient's Health Belief Model of Care

PURPOSE OF REVIEW

Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed.

RECENT FINDINGS

Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care.

Linking heart and mind - lived experiences of parents to children with congenital heart disease and mental health issues

Children with congenital heart disease are more likely to receive special educational services in schools and have an increased risk of mental health issues. We explored the lived experiences of parents caring for a child with heart disease and concurrent mental health issues in Denmark. Semi-structured interviews with ten parents (age 39-57 years) to these children (age 5-17 years) were analysed using interpretative phenomenological analysis. Three Group Experiential Themes (GETs) were generated from the analysis: The first GET, Parental roles and caring behaviours, described parental struggles of fulfilling their parenting role ideals and experiences with stigmatization of MHI. GET two, Parental reflections on their illness explanations, portrayed how parents utilize different illness explanations to make sense of their child's MHI. GET three, Differences in access to help and support, captured how the CHD affected overall access to mental health support. The results may inform various topics of importance for health professionals to address in their clinical encounters with these families.

Prevalence of Complementary Medicine Use in Children and Adolescents: A Systematic Review

INTRODUCTION

The objective of this systematic review was to determine the global prevalence of complementary medicine (CM) use among children and adolescents.

METHOD

Seven databases and the reference lists of included studies were searched for pertinent observational studies. Studies were limited to those published in English from July 1, 2013. Included studies were appraised using the JBI checklist for prevalence studies.

RESULTS

Twenty studies were eligible for inclusion (385,527 participants). Most studies were assessed as having low risk of bias. Meta-analyses revealed a 23.0% (95% confidence interval, 0.226-0.234; 17 studies) short-term (≤ 12 month) prevalence and a 77.7% (95% confidence interval, 0.760-0.794; six studies) lifetime prevalence of CM use in children and adolescents. Differences in CM use were evident across countries and regions.

DISCUSSION

The findings of this review indicate that the use of CM in children and adolescents is high and widespread and may be increasing.

Qualitative Assessment CIH Institutions' Engagement With Underserved Communities to Enhance Healthcare Access and Utilization

Background

In North America, there is a notable underutilization of complementary and integrative health approaches (CIH) among non-White and marginalized communities.

Objectives

This study sought to understand how CIH educational instutitions are proactively working to redress this disparity in access and utilization among these communities.

Methods

We conducted interviews with 26 key informants, including presidents, clinicians, and research deans across 13 CIH educational institutions across the US and Canada. Thematic analysis included deductive codes based on the interview guide during interview scripts review.

Results

Six themes were identified: (1) CIH institutions often had a long and varied history of community engaged care through partnerships to increase access and utilization; (2) CIH institutions' long-standing community outreach had been intentionally designed; (3) CIH institutions provided an array of services to a wide range of demographics and communities; (4) addressing healthcare access and utilization through community partnerships had a strong positive impact; (5) funding, staffing and COVID-19 were significant challenges that impeded efforts to increase CIH access through community engaged work; (6) identified gaps in community partnerships and services to increase access and utilization were recognized.

Conclusion

These findings underscore significant efforts made to enhance healthcare access and utilization among marginalized, underserved, and racial and ethnic communities. However, barriers such as funding constraints, resource allocation, and the need for proper measurement and accountability hinder proactive initiatives aimed at redressing disparities in CIH utilization within these communities.

The engagement of psychology with complementary medicine: A critical integrative review

Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists' engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.

Predicting intervention use in autistic children: Demographic and autism-specific characteristics

LAY ABSTRACT

Autism is a condition that is characterised by social communication difficulties and restrictive and repetitive behaviours or interests. Autism can present in many different ways and various interventions are available. Some interventions are conventional, and they are recommended to be used for children with autism (guideline therapies) or for other disorders such as anxiety or attention-deficit hyperactivity disorder (mainstream therapies or medication), while others are less conventional (other therapies or medication, they are discouraged, unknown or alternative). Little is known about who chooses which intervention. This study found that most autistic children use some kind of intervention. Children who attend special education or have an additional diagnosis (other than autism) tend to receive more therapies, while children with a lower IQ receive fewer therapies. Older children, children with a higher IQ and girls are more likely to use conventional (mainstream or guideline) therapies. Children whose parents have a lower educational level are more likely to have used conventional medication. Whereas, children with more sensory issues (e.g. sensitivity to sound, smell or movement) were more likely to have used unconventional medication. This study found that other autism-related characteristics such as the number of autism symptoms, social skills and repetitive and restrictive behaviours were not related to the interventions used. More treatments focussed on multiple problems should be available for children with autism who have additional difficulties.

Perceptions of Health Professionals on the Implementation of Integrative and Complementary Practices at a University Pediatric Hospital in Brazil: A Qualitative Interview Study

BACKGROUND

Despite an increase in use of pediatric complementary and integrative health (PCIH), many healthcare professionals still have an inadequate understanding of such practices and consider their use inappropriate, which might thwart implementation processes. In a qualitative interview study we examined the feedback of conventional healthcare professionals about the integrative practices provided to pediatric patients by an integrative team in a pediatric oncological hospital.

METHODS

Fifteen semi-structured interviews were carried out with various conventional healthcare professionals in an university pediatric hospital in São Paulo, Brazil. The interviews were audio-recorded, transcribed and pseudonymized. DSCsoft® and MAXQDA® software assisted in a profound qualitative analysis using the collective subject discourse and thematic analysis method in order to display participants' perspectives on PCIH and the project in their hospital.

RESULTS

Interviewees acknowledged their lack of knowledge about PCIH practices and reflected on the limits of their care as well as on new possibilities PCIH could offer. PCIH was perceived by interviewees as an effective supportive tool of care to promote patients' wellbeing, assist overall compliance, strengthen cooperation between professionals, children and their relatives and hence facilitated general patient care. Since PCIH was implemented in their clinic, perceptions led interviewees to wish for increased PCIH offering and a more profound integration of its therapists into the standard of care.

DISCUSSION

The coexistence of integrative and conventional practices in the conventional healthcare setting is important to give visibility to the possibilities offered by the integrative pediatrics field. Regular and constant encounters with integrative practices, as well as information access seem crucial to reach a wider openness for PCIH and subsequently a broader application and dissemination of it.

Complementary and Alternative Medicine Use by ADHD Patients: A Systematic Review

OBJECTIVE

This study aimed to review the prevalence of complementary and alternative medicine (CAM) use and its different used types, characteristics of the studied cohorts, the reasoning for CAM use, and possible predictive factors for its use amongst ADHD patients.

METHOD

The Web of Science Core Collection, PubMed, and Scopus were searched from inception to 10 February 2022. All of the original papers published in English which report data on CAM use by patients with ADHD were included.

RESULTS

Twelve original researches including 4,447 patients were included. The prevalence of CAM use varied from 7.5% to 67.6%. The most-reported CAM modalities were dietary modifications and natural products. Moreover, higher parental education should be considered as a predictive factor for CAM use.

CONCLUSION

CAM use by ADHD patients seems to be prevalent. Healthcare providers should be trained about the most commonly used CAM therapies and their possible adverse events.

Predicting Children with ADHD Using Behavioral Activity: A Machine Learning Analysis

Attention deficit hyperactivity disorder (ADHD) is one of childhood’s most frequent neurobehavioral disorders. The purpose of this study is to: (i) extract the most prominent risk factors for children with ADHD; and (ii) propose a machine learning (ML)-based approach to classify children as either having ADHD or healthy. We extracted the data of 45,779 children aged 3–17 years from the 2018–2019 National Survey of Children’s Health (NSCH, 2018–2019). About 5218 (11.4%) of children were ADHD, and the rest of the children were healthy. Since the class label is highly imbalanced, we adopted a combination of oversampling and undersampling approaches to make a balanced class label. We adopted logistic regression (LR) to extract the significant factors for children with ADHD based on p-values (<0.05). Eight ML-based classifiers such as random forest (RF), Naïve Bayes (NB), decision tree (DT), XGBoost, k-nearest neighborhood (KNN), multilayer perceptron (MLP), support vector machine (SVM), and 1-dimensional convolution neural network (1D CNN) were adopted for the prediction of children with ADHD. The average age of the children with ADHD was 12.4 ± 3.4 years. Our findings showed that RF-based classifier provided the highest classification accuracy of 85.5%, sensitivity of 84.4%, specificity of 86.4%, and an AUC of 0.94. This study illustrated that LR with RF-based system could provide excellent accuracy for classifying and predicting children with ADHD. This system will be helpful for early detection and diagnosis of ADHD.

Profiles and predictors of healthcare utilization: using a cluster-analytic approach to identify typical users across conventional, allied and complementary medicine, and self-care

Introduction

The identification of typologies of health care users and their specific characteristics can be performed using cluster analysis. This statistical approach aggregates similar users based on their common health-related behavior. This study aims to examine health care utilization patterns using cluster analysis; and the associations of health care user types with sociodemographic, health-related and health-system related factors.

Methods

Cross-sectional data from the 2012 National Health Interview Survey were used. Health care utilization was measured by consultations with a variety of medical, allied and complementary health practitioners or the use of several interventions (exercise, diet, supplementation etc.) within the past 12 months (used vs. not used). A model-based clustering approach based on finite normal mixture modelling, and several indices of cluster fit were determined. Health care utilization within the cluster was analyzed descriptively, and independent predictors of belonging to the respective clusters were analyzed using logistic regression models including sociodemographic, health- and health insurance-related factors.

Results

Nine distinct health care user types were identified, ranging from nearly non-use of health care modalities to over-utilization of medical, allied and complementary health care. Several sociodemographic and health-related characteristics were predictive of belonging to the respective health care user types, including age, gender, health status, education, income, ethnicity, and health care coverage.

Conclusions

Cluster analysis can be used to identify typical health care utilization patterns based on empirical data; and those typologies are related to a variety of sociodemographic and health-related characteristics. These findings on individual differences regarding health care access and utilization can inform future health care research and policy regarding how to improve accessibility of different medical approaches.

Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary

Naturopathic medicine is a growing profession in North America that provides expertise in complementary and alternative, or integrative care to pediatric patients. It is imperative that healthcare providers have an understanding of the training and scope of other health professionals in order to effectively make decisions regarding research, collaborative clinical care, and policy. Given the prevalence of use of complementary and alternative medicine by children and families in North America, and the growing interest in "integrative" medicine, we aim to offer an overview of naturopathic care for children. This document describes the principles, training, and scope of naturopathic medicine, including health promotion, disease prevention, and illness management. It describes the process by which naturopathic doctors create an integrative healthcare plan for children, evaluate and apply evidence, and integrate ethical issues in practice management, and speaks to the role naturopathic doctors have regarding advocacy for community and planetary health as it relates to pediatrics.

Use of Psychics for Stress and Emotional Problems: A Descriptive Survey Comparison with Conventional Providers and Informal Helpers

Conventional mental health treatments do not meet the needs of all who seek help: some consult informal and alternative providers. Researching the use and perceived benefits of these non-conventional sources of help may contribute to understanding help-seeking behavior and inform mental health policy. We explored the experiences of people consulting psychics (a type of alternative provider) for mental health needs, through comparisons with experiences of people consulting conventional and informal providers. An online survey sought feedback on help seeking for stress or emotional problems from 734 adults who had consulted a psychologist or counsellor; doctor or psychiatrist who prescribed medication; friend or family member; or psychic or similar alternative provider. Analyses included descriptive and inferential statistics and content analysis of textual responses. Problems were commonly described in symptom or disorder terminology with considerable overlap across groups. Content analysis of reasons for choice of helper identified four main categories-functional, reasoned, emotional, and passive-which differed significantly across groups (Cramer's V = 0.26), with consulting psychics predominantly a reasoned choice. Ratings of overall effectiveness of help by those consulting psychics were greater than for the three other groups (d = 0.31 to 0.42), with very few adverse outcomes in any group. Help seeking for stress or emotional problems includes consultations with psychics or similar alternative providers, with self-reported outcomes better than for conventional providers. Further research is warranted to establish whether psychic consultations may serve a useful public health function.

The use and benefits of Craniosacral Therapy in primary health care: A prospective cohort study

BACKGROUND

Patients frequently use treatments complementary to standard primary care. This prospective cohort-study examined the use, benefits, and safety of Craniosacral Therapy (CST).

METHODS

Consecutive out-patients utilizing CST from 2015 to 2019 were asked to provide anonymized data on symptom intensity, functional disability, and quality of life before and after treatment using an adapted 11-point numerical rating scale (NRS) version of the Measure Yourself Medical Outcome Profile (MYMOP). Treatment expectations were assessed as were concurrent therapies/medication and safety. Mean differences were analyzed using paired sample t-tests with 95 % confidence intervals (CI), predictors of treatment response using linear regression modelling.

RESULTS

CST therapists submitted 220 patient records (71.4 % female) including 15.5 % infants and toddlers, 7.7 % children, and 76.8 % adolescents and adults. Patients received on average 7.0 ± 7.3 CST sessions to treat 114 different, acute and chronic conditions. Symptom intensity significantly decreased by -4.38 NRS (95 %CI=-4.69/-4.07), disability by -4.41 NRS (95 %CI=-4.78/-4.05), and quality of life improved by 2.94 NRS (95 %CI = 2.62/3.27). Furthermore, CST enhanced personal resources by 3.10 NRS (95 %CI = 1.99/4.21). Independent positive predictors of change in the adapted total MYMOP score included patients' expectations (p = .001) and therapists' CST experience (p = .013), negative predictors were symptom duration (p < .002) and patient age (p = .021); a final categorical predictor was CST type (p = .023). Minor but no serious adverse events occurred.

CONCLUSIONS

In primary care, patients and parents of underage children use CST for preventive and therapeutic purposes. Considering the design limitations, CST appears to be overall effective and safe in infants, children, and adults.

Complementary and alternative medicine for urinary tract illnesses: A cross-sectional survey in Jordan

The aim of this study was to assess the extent of Complementary and Alternative Medicine (CAM) usage, especially herbal preparations, in treating urinary tract illnesses, and their perceived efficacy. This was a cross-sectional survey that used a convenience sample of 278 adults who reported having any form of urinary tract illness. During the last 3 months, 105 (37.8%) of participants had used CAM for various urinary tract conditions, of which, 87 (82.9%) used herbal remedies. Urinary tract infections (UTIs) were the most reported urinary condition (n = 77, 73.3%) among CAM users. The most commonly used herbs were, parsley (n = 54, 19.2%), followed by chamomile (n = 29, 10.4%), barley (n = 20, 7.4%) and ginger (n = 18, 6.7%).The study provides an overview of various CAM remedies used to treat urinary tract illnesses in the Jordanian society, which would draw attention to the necessity of conducting interventional studies to evaluate the efficacy and safety of CAMs in treating urinary tract illnesses, either as stand-alone or adjuvant treatment.

Mind-Body Physical Activity Interventions and Stress-Related Physiological Markers in Educational Settings: A Systematic Review and Meta-Analysis

Mind–Body Physical Activity (MBPA) in educational settings is one possible preventive strategy for ameliorating stress-related physiological health parameters. The objectives of this study were to conduct a systematic review of the literature with meta-analyses on the effects of MBPA on stress-related physiological health markers in primary, secondary, and higher education students. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the search for peer-reviewed articles published in English was conducted in PubMed, EBSCOhost, PsychInfo, Scopus, and Cochrane Library databases. Criteria for inclusion consisted of empirical studies targeting the student population (primary, secondary, higher education), studies examining the effectiveness of an MBPA intervention, studies including a control or comparison group (pre-test/post-test studies excluded), studies targeting physiological marker outcomes such as heart rate, blood glucose, cortisol, and blood pressure, and finally, studies examining interventions implemented within educational settings. Twenty-six interventions were eligible for the review and quantitative synthesis, which comprised a total of 1625 participants, with 783 students serving within the control/comparison group. There were statistically significant and large pooled effects for MBPA effectiveness for lowering heart rate (Hedges’ g = −1.71, 95% Confidence Interval (CI): −2.43, −0.98), cortisol (Hedges’ g = −1.32, 95% CI: −2.50, −0.16), and systolic and diastolic blood pressure (Hedges’ g = −1.04, 95% CI: −1.53, −0.58). These effects tended to be stronger in older students compared to younger students. Most analyses were characterized as having high heterogeneity and only 10 of the 26 studies were characterized as good quality (38.4%). MBPA interventions may have a positive impact on specific physiological health markers in students, especially in students within higher education. However, higher-quality research is needed in this area.

How can we improve the safe use of herbal medicine and other natural products? A clinical pharmacologist mission

INTRODUCTION

Three major classes of natural products (NPs) for medicinal purposes or improving wellbeing are generally available in the US: conventional drugs of herbal origin, botanical drugs, and dietary supplements (DSs). Consumer consumption of DSs is growing annually. The U.S. FDA regulates conventional and botanical drugs for safety and efficacy; however, DSs are minimally regulated.

AREAS COVERED

This article will: i) highlight the importance of NP as a significant source of prescription drugs; ii) discuss differences in the regulation of conventional drugs of NP product, botanical drugs, and DSs; iii) discuss the safety and efficacy of DSs and iv) make recommendations for improvement of safety for minimally regulated NPs.

EXPERT OPINION

Toxicities associated with the use of NPs, including vitamins and DSs, are mainly due to excessive use and interactions with conventional drug(s) and may represent challenges for clinicians. Conventional and botanical-based prescription drugs are rarely associated with unknown toxicities. However, DSs are minimally regulated and can produce severe adverse effects. We believe that clinical pharmacologists can have a role in developing criteria for DS safety analysis. There is also the potential for a standardized NP stewardship program(s) and the development of NP policies and practices nationally and globally.

Sleeping without Prescription: Management of Sleep Disorders in Children with Autism with Non-Pharmacological Interventions and Over-the-Counter Treatments

Autism Spectrum Disorders (ASD) are lifelong neurodevelopmental conditions characterized by abnormal social interaction, communication, and behavior. Sleep disturbances represent a common comorbidity in children and adolescents with ASD, with prevalence ranging from 50 to 80%. It has been proved that sleep disruption worsens the symptoms of autism and results in challenging behaviors. Improving sleep should therefore be a primary therapeutic goal. Treatment options range from lifestyle modifications to pharmacological therapy. Several reviews have been written on pharmacological treatments, but very few on the beneficial effects of non-pharmacological interventions, over-the-counter drugs, and nutritional supplements. This study consists of a narrative review of the literature, presenting the available evidence on the following treatments: sleep education, behavioral interventions, complementary and alternative medicine (special mattresses and blankets, massage, aromatherapy, yoga, physical activity), and commonly used over-the-counter medications and supplements (antihistamines, melatonin, tryptophan, carnosine, iron, vitamins, and herbal remedies). For some treatments—such as melatonin and behavioral interventions—effectiveness in ASD is well established in the literature, while other interventions appear of benefit in clinical practice, even if specific studies in children and adolescents with ASD are lacking. Conversely, other treatments only seem to show anecdotal evidence supporting their use.

Use of complementary and alternative medicine treatments by mothers of children with developmental disabilities: a cross sectional study

This study aims to determine the rates of complementary and alternative medicine methods used by mothers of children with developmental disabilities, reasons for using methods, and comparison of methods according to diagnosis groups. The cohort in this cross-sectional and correlational study consisted of the mothers of 390 students with developmental disabilities; 77.2% of the mothers reported using at least one complementary and alternative medicine treatment. The highest level of use was found in the groups of mothers of children with cerebral palsy (100%) and autism spectrum disorder (88.5%). The most commonly used treatments were biological therapies consisting of special diets and multivitamins, manipulative and body-based methods including massage and exercise, and mind-body interventions such as prayer, wearing amulets, and seeking help from a Muslim preacher (hodja). However, mothers never used alternative medicine treatments such as homeopathy, acupuncture, or Ayurveda, nor did they use energy-based healing techniques such as reiki, tai chi, yoga, kinesiology, or neurofeedback exercises. Health care professionals, especially nurses as health care team members, should be knowledgeable and careful about the benefits, side effects, administration methods, and contraindications of complementary and alternative medicine treatments.

Natural Health Product-Drug Interaction Causality Assessment in Pediatric Adverse Event Reports Associated with Attention-Deficit/Hyperactivity Disorder Medication

Background: Some pediatric patients with attention-deficit/hyperactivity disorder (ADHD) use natural health products (NHPs) such as herbal remedies. Although herbal remedies are generally considered to be safe when they are used appropriately, they may contain active components that can interact with medications being used concurrently, with potential for NHP-drug interactions leading to adverse events. Objectives: The objectives of this study were (1) to identify adverse event reports (AERs) involving commonly used herbal remedies and ADHD prescription medicines in children and adolescents; (2) to evaluate the quality of collected AERs; and (3) to assess whether NHP-drug interactions can be causally linked to reported adverse events. Methods: We systematically searched the FDAble database (FDAble.com) for herbal remedies commonly used by patients (4-18 years old) also taking ADHD drugs from 1997 to 2015. We assessed the completeness of the AERs and used three causality assessment tools modified for NHPs (Naranjo Adverse Drug Reaction Probability Scale, HORN Drug Interaction Probability Scale, and World Health Organization Uppsala Monitoring Centre Scale). Results: Of the 23 identified AERs involving both an herbal remedy and an ADHD prescription medication, most involved multiple (>3) substances with inadequate detail to assess multiple potential interactions. Following data extraction and evaluation of completeness, five AERs involving only one herbal remedy and one ADHD medication were evaluated for causality. An NHP-drug interaction was assessed to be probable in one case and to be possible in another. Both these reports involved a methylphenidate formulation and St. John's wort. Conclusions: Eighteen of the 23 identified AERs involving both an herbal remedy and an ADHD drug also involved other multiple ingredient products. The reporting quality was poor for the five AERs examined. Further research is needed to study the interaction between St. John's wort and methylphenidate.

Study of Natural products Adverse Reactions (SONAR) in children seen in mental health clinics: a cross-sectional study

BACKGROUND

Paediatric mental health patients frequently use natural health products (NHP) in addition to prescription medications, but very little is known about adverse events and possible NHP-drug interactions.

OBJECTIVE

To determine: (1) the prevalence of paediatric mental health patients taking prescription medications only, NHP only, both NHP and prescription medications concurrently or neither; (2) which prescription medications and NHP are most commonly used in paediatric mental health populations and (3) adverse events experienced in the last 30 days (serious and non-serious).

DESIGN

Cross-sectional surveillance study.

SETTING

Paediatric mental health clinics.

POPULATION/INTERVENTION

On their first clinic visit, paediatric mental health patients were provided with a form inquiring about prescription drug use, NHP use and any undesirable event experienced in the last month.

RESULTS

Of the 536 patients included in this study, 23% (n=120) reported taking only prescription medication(s), 21% (n=109) reported only NHP use, 21% (n=112) reported using both NHP and prescription drugs concurrently, and 36% (n=191) reported using neither. Overall, there were 23 adverse events reported; this represents 6.3%, 2.8%, 10.8% and 0.6% of each population, respectively. The majority of patients who experienced an adverse event reported taking more than one NHP or prescription drug. No serious adverse events were reported.

CONCLUSION

Nearly half of the paediatric mental health patients in this study were taking NHPs alone or in addition to prescription medications. Active surveillance identified multiple adverse events associated with NHP and prescription drug use; none were serious. Healthcare professionals were encouraged to initiate conversations regarding NHP use.

U.S. Physician Recommendations to Their Patients About the Use of Complementary Health Approaches

Objective: There are no nationally representative studies using a probability sample that have been published examining whether physicians recommend complementary health approaches (CHAs) to their patients, as previous research has focused only on selected medical specialties or a particular U.S. region. This article fills a void in the current literature for robust data on recommendations for CHAs by office-based physicians in the United States. Design: Descriptive statistics and multivariable regression analyses of physician-level data were from the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians. Weighted response rate among eligible physicians sampled for the 2012 NAMCS PII was 59.7%. Setting/Location: United States. Outcome measures: Recommendations by physicians to their patients for any CHA, and individual CHAs: massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind-body therapies. Differences in recommendations by physician demographic characteristics were identified. Results: Massage therapy was the most commonly recommended CHA (30.4%), followed by chiropractic/osteopathic manipulation (27.1%), herbs/nonvitamin supplements (26.5%), yoga (25.6%), and acupuncture (22.4%). The most commonly recommended CHAs by general/family practice physicians were chiropractic/osteopathic manipulation (54.0%) and massage therapy (52.6%). Of all U.S. physicians, 53.1% recommended at least one CHA to patients during the previous 12 months. Multivariable analyses found physician's sex, race, specialty, and U.S. region to be significant predictors of CHA recommendations. Female physicians were more likely than male physicians to recommend massage therapy (adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI] = 1.40-2.20), herbs/nonvitamin supplements (aOR = 1.85, 95% CI = 1.46-2.35), yoga (aOR = 2.16, 95% CI = 1.70-2.75), acupuncture (aOR = 1.65, 95% CI = 1.27-2.13), and mind-body therapies (aOR = 2.63, 95% CI = 2.02-3.41) to patients. Psychiatrists (aOR = 0.13, 95% CI = 0.07-0.23), OB/GYNs (aOR = 0.38, 95% CI = 0.24-0.60), and pediatricians (aOR = 0.26, 95% CI = 0.18-0.38) were all less likely to recommend chiropractic/osteopathic manipulation than general and family practitioners. Conclusions: Overall, more than half of office-based physicians recommended at least one CHA to their patients. Female physicians recommended every individual CHA at a higher rate than male physicians except for chiropractic and osteopathic manipulation. These findings may enable consumers, physicians, and medical schools to better understand potential differences in use of CHAs with patients.