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Ghadiri P, Yaffe MJ, Adams AM, Abbasgholizadeh-Rahimi S. Primary care physicians' perceptions of artificial intelligence systems in the care of adolescents' mental health. BMC PRIMARY CARE 2024; 25:215. [PMID: 38872128 PMCID: PMC11170885 DOI: 10.1186/s12875-024-02417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks. METHODS We used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis. RESULTS We reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients' data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm. CONCLUSION This study provides the groundwork for assessing PCPs' perceptions of AI systems' features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents' perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.
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Affiliation(s)
- Pooria Ghadiri
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
- Mila-Quebec AI Institute, Montréal, QC, Canada
| | - Mark J Yaffe
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
- St. Mary's Hospital Center of the Integrated University Centre for Health and Social Services of West Island of Montreal, Montréal, QC, Canada
| | - Alayne Mary Adams
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
| | - Samira Abbasgholizadeh-Rahimi
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada.
- Mila-Quebec AI Institute, Montréal, QC, Canada.
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montréal, QC, Canada.
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Austin EE, Cheek C, Richardson L, Testa L, Dominello A, Long JC, Carrigan A, Ellis LA, Norman A, Murphy M, Smith K, Gillies D, Clay-Williams R. Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Front Psychiatry 2024; 15:1368129. [PMID: 38487586 PMCID: PMC10937575 DOI: 10.3389/fpsyt.2024.1368129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Background Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness. Method We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools. Results A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging. Conclusion Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.
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Affiliation(s)
- Elizabeth E. Austin
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Colleen Cheek
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Lieke Richardson
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Luke Testa
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Amanda Dominello
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Janet C. Long
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Ann Carrigan
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Louise A. Ellis
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Alicia Norman
- Centre for the Health Economy, Macquarie University Business School, Macquarie University, Macquarie, NSW, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
| | - Kylie Smith
- Emergency Care Institute, New South Wales Agency for Clinical Innovation, New South Wales Health, Sydney, NSW, Australia
| | - Donna Gillies
- Quality and Safeguards Commission, National Disability Insurance Scheme, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
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3
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Borg D, Hall K, Youssef GJ, Sloan E, Graeme L, Moulding R. Examining the role of brooding, distress, and negative urgency in dysregulated behaviors: A cross-sectional study in treatment-seeking young people. J Clin Psychol 2022; 78:2538-2563. [PMID: 35506609 PMCID: PMC9790647 DOI: 10.1002/jclp.23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/21/2022] [Accepted: 04/15/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Dysregulated behaviors including substance use, disordered eating, and nonsuicidal self-injury (NSSI) have significant negative implications for individuals and health systems. It is therefore paramount to understand factors influencing behavioral dysregulation, to inform prevention and treatment approaches. The literature suggests that distress and rumination (brooding) prompt individuals to engage in behavioral dysregulation for distraction (Emotional Cascade Model), although these concepts have limited investigation in clinical, treatment-seeking samples, particularly alongside negative urgency. This cross-sectional study sought to examine the relationships of brooding, distress, and negative urgency with behavioral dysregulation, as well as the moderating effect of negative urgency between brooding and behavioral dysregulation, in treatment-seeking young people. METHOD A total of 385 treatment-seeking young people completed cross-sectional, self-report measures of distress, rumination, negative urgency, and engagement in dysregulated behaviors (NSSI, alcohol use, drug use, binge eating, and purging) over the past 1-3 months. RESULTS Structural equation modeling revealed that only negative urgency, and not brooding or distress, had a significant positive relationship with behavioral dysregulation. Negative urgency did not significantly moderate the relationship between brooding and behavioral dysregulation. CONCLUSIONS These findings reinforce the importance of considering negative urgency in the conceptualization, prevention, and treatment of behavioral dysregulation, and contribute to the knowledge of the relationship between brooding and various dysregulated behaviors within a treatment-seeking sample.
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Affiliation(s)
- Dana Borg
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Kate Hall
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Centre for Social and Early Emotional DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - George J. Youssef
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Centre for Social and Early Emotional DevelopmentDeakin UniversityGeelongVictoriaAustralia,Center for Adolescent HealthMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Elise Sloan
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Liam Graeme
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Centre for Social and Early Emotional DevelopmentDeakin UniversityGeelongVictoriaAustralia
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Psycho-Behavioral Profiles of Pediatric Inpatients with Past and Recent Onset of Nonsuicidal Self-Injury: A Cluster Analysis Approach. J Clin Med 2022; 11:jcm11154602. [PMID: 35956216 PMCID: PMC9369878 DOI: 10.3390/jcm11154602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Few studies have focused on the persistence of nonsuicidal self-injury (NSSI) over time in developmental age. This study aimed to define the psycho-behavioral profiles of young inpatients according to past or recent NSSI onset (i.e., NSSI for more or less than one year, respectively), and identify possible risk factors for maintaining NSSI over time. A total of 118 Italian NSSI inpatients aged 9–17 were involved. The Youth Self-Report (YSR) was administered. K-means cluster analyses were conducted using the YSR affective disorders, social competencies, and social problems scales as clustering variables. A binomial logistic regression was run to clarify which of these variables discriminate between the past and recent NSSI onset groups. Chi-square tests were performed to pinpoint the variables associated with long-standing NSSI. The final cluster solution displayed four psycho-behavioral profiles; a greater number of inpatients with recent NSSI onset was found in the clusters characterized by scarce social competencies. Affective disorders and social competencies were significant predictors, and higher scores on both scales were more likely in the past NSSI onset group. School problems and alcohol/substance use were related to long-standing NSSI. Therefore, a lack of social skills may be involved in recent NSSI onset, while affective disorders and other problem behaviors may dictate the continuation of NSSI over time.
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5
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Kasemy ZA, Sharif AF, Amin SA, Fayed MM, Desouky DE, Salama AA, Abo Shereda HM, Abdel-Aaty NB. Trend and epidemiology of suicide attempts by self-poisoning among Egyptians. PLoS One 2022; 17:e0270026. [PMID: 35709176 PMCID: PMC9202942 DOI: 10.1371/journal.pone.0270026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63-27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10-27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90-2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45-8.42) and 14.11% (CI95%: 12.4-16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25-40 years old (OR = 27.49, CI95%: 15.28-49.64 and OR = 59.42, CI95%: 32.76-107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32-57.56 and OR = 14.11, CI95%: 10.86-18.43 respectively), students (OR = 2.91, CI95%: 1.57-5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27-5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning.
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Affiliation(s)
- Zeinab A. Kasemy
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Asmaa Fady Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Clinical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Safaa Abdelzaher Amin
- Department of Forensic medicine and clinical toxicology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Manar Maher Fayed
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dalia E. Desouky
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amal A. Salama
- Department of Family medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Hanaa Mohammad Abo Shereda
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Menoufia University, Menoufia, Egypt
| | - Nehad B. Abdel-Aaty
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Poyraz Fındık OT, Erdoğdu AB, Fadıloğlu E, Rodopman Arman A. Emergency Department Visits for Non-suicidal Self-harm, Suicidal Ideation, and Suicide Attempts in Children and Adolescents. Child Psychiatry Hum Dev 2022; 53:289-299. [PMID: 33523341 DOI: 10.1007/s10578-021-01125-6] [Citation(s) in RCA: 4] [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] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Self-harm presentations to emergency departments (ED) have become a growing concern, yet little is known about self-harm visits in pediatric EDs. This study aimed to investigate the clinical and demographic characteristics of patients who presented to the pediatric ED between 2012 and 2017 with non-suicidal self-harm (NSSH, n = 63, 60.3% female, M = 14.25 years), suicidal ideation (SI, n = 75, 57.3% female, M = 14.83 years), and suicide attempts (SA, n = 461, 82.9% female, M = 15.41 years). Also, predictors of SA were investigated. Of the patients, 79.4% had at least a psychiatric disorder. Depression was the most common diagnosis in the SI and SA groups, and autism spectrum disorder and intellectual disability were the leading diagnoses in the NSSH group. Self-poisoning was the most common method, and older age, female sex, having relational problems, and prior or current psychiatric admissions were the most important predictive factors of SA. NSSH, SI, and SA exhibit different features in early life. EDs provide an important opportunity for initiating developmentally appropriate interventions to reduce future risks.
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Affiliation(s)
- Onur Tuğçe Poyraz Fındık
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Pendik Research and Training Hospital, Istanbul, Turkey.
| | - Ayşe Burcu Erdoğdu
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Eray Fadıloğlu
- Child and Psychiatry Clinic, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Ayşe Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
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7
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Cozzi G, Passaglia L, Agrusti A, Giangreco M, Giorgi R, Barbi E. Adolescents' Utilization of a Tertiary-Level Pediatric Emergency Department in Italy. Front Pediatr 2022; 10:750403. [PMID: 35359905 PMCID: PMC8960306 DOI: 10.3389/fped.2022.750403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Describe the use of the emergency department of a tertiary-level children's hospital in Italy by adolescents. Methods This retrospective study was based on the medical records of patients aged 13 to 17 years, who accessed the emergency department of the Institute for Maternal and Child Health of Trieste, from 1 January to 31 December 2018. The primary outcome was to describe the leading causes of access, diagnoses, rate of hospitalization, and ward of destination among adolescent patients. Results During the study period, 24,599 patients accessed the department. Among them, 3,062 were adolescents, for a total of 3,895 unscheduled visits. The principal causes of access were trauma (45.3%) and organic diseases (38.8%). Two hundred and forty nine adolescents (6.4%) had mental health problems. One hundred and forty two adolescents (3.6%) Were Admitted to the Hospital, 54 of Whom (38%) to the Neuropsychiatric Ward, for Mental Health Problems. Conclusions Among adolescents seen in this Italian tertiary-level children's hospital, mental health problems represented a small proportion of emergency department visits but were the leading cause of urgent hospitalization.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Rita Giorgi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
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8
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Østervang C, Geisler Johansen L, Friis-Brixen A, Myhre Jensen C. Experiences of nursing care for patients who self-harm and suggestions for future practices: The perspectives of emergency care nurses. Int J Ment Health Nurs 2022; 31:70-82. [PMID: 34506045 DOI: 10.1111/inm.12933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Self-harm is a major challenge in healthcare systems. Emergency department nurses provide care to numerous patients with self-harm injuries. Accordingly, nurse-patient interactions are vital to improve the physical and psychological outcomes of this complex patient group. Previous studies have proposed the establishment of improved teaching programs to increase the competence of emergency department nurses within mental health care; however, few studies have comprehensively investigated the experiences and suggestions for future nursing practices. Therefore, we gathered in-depth knowledge of Danish emergency department nurses' experiences caring for patients who self-harm and obtained their suggestions on future nursing practices. Ten semi-structured interviews were conducted to capture the nurses' individual perspectives. The scientific theory is based on phenomenology and hermeneutics. Interpretative phenomenological analysis was used, and three themes were identified: (i) importance of having the competences to establish a relationship in the acute phase; (ii) acute care from a biomedical perspective; and (iii) highlighting ideas for improved future practices. The emergency department nurses were aware of the importance of mental health care but found their competence and motivation situated in medical care. The nurses felt that they lacked skills to undertake in-depth mental care for patients who self-harm and that the healthcare system failed to help this group of patients. Based on these findings, rather than aiming at improving nursing skills, we suggest a close collaboration between the emergency and psychiatric departments to improve the quality of care for patients who self-harm. We also recommend organizational changes within the emergency department, such as the introduction of a so-called 'social track'.
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Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laerke Geisler Johansen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | - Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics Surgery and Traumatology, University of Southern Denmark, Odense, Denmark
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Zanato S, Miscioscia M, Traverso A, Gatto M, Poli M, Raffagnato A, Gatta M. A Retrospective Study on the Factors Associated with Long-Stay Hospitalization in a Child Neuropsychiatry Unit. Healthcare (Basel) 2021; 9:1241. [PMID: 34575015 PMCID: PMC8465245 DOI: 10.3390/healthcare9091241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
The past twenty years have seen a rapid increase in acute psychiatric symptoms in children and adolescents, with a subsequent rise in the number of psychiatric hospitalizations. This paper aims to: (a) describe the epidemiology of hospitalizations and some of the clinical and sociodemographic characteristics of pediatric patients admitted to a regional referral Complex Operative Child Neuropsychiatry Hospital Unit in Northeast Italy and (b) identify potential factors correlated with the length of hospital stay. METHODS 318 (M = 12.8 years; SD = 3.11; 72% Female) patients hospitalized for mental health disorders from 2013 to 2019. RESULTS Around 60% of hospital admissions occurred via the emergency room, mostly due to suicidal ideation and/or suicide attempts (24%). Affective disorders were the most frequent discharge diagnosis (40%). As for factors correlated with length of hospital stay, we found significant links with chronological age, way of hospital admission, cause of admission, discharge diagnosis, presence of psychiatric comorbidity, family conflict, and psychiatric family history. CONCLUSIONS These results provide information about global characteristics associated with the length of psychiatric hospital stays in pediatric patients and provide a basis on which specific precautions can be hypothesized with the aim of developing more focused treatments.
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Affiliation(s)
- Silvia Zanato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Annalisa Traverso
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Miriam Gatto
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Mikael Poli
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
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10
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Klomek AB, Catalan LH, Apter A. Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents. World J Psychiatry 2021; 11:403-411. [PMID: 34513604 PMCID: PMC8394689 DOI: 10.5498/wjp.v11.i8.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Suicidal behaviors in adolescence are a major public health concern. The dramatic rise in self-injurious behaviors among adolescents has led to an overwhelming increase in the number of those presenting to the emergency rooms. The intervention described below was constructed on the basis of brief and focused interventions that were found to be effective among suicidal adults using an adaptation of interpersonal psychotherapy for adolescents. The intervention has four main objectives: first, a focused treatment for reducing suicide risk; second, a short and immediate response; third, building a treatment plan based on understanding the emotional distress and interpersonal aspects underlying suicidal behavior; and lastly, to generate hope among adolescents and their parents. The intervention includes intensive five weekly sessions, followed by 3 mo of email follow-up.
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Affiliation(s)
- Anat Brunstein Klomek
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya 4610101, Israel
| | - Liat Haruvi Catalan
- Depression and Suicide Clinic, Schneider Children’s Medical Center, Petach Tikva 49202, Israel
| | - Alan Apter
- Depression and Suicide Clinic, Schneider Children’s Medical Center, Petach Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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11
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A Qualitative Account of Young People's Experiences Seeking Care from Emergency Departments for Self-Harm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062892. [PMID: 33808995 PMCID: PMC8000083 DOI: 10.3390/ijerph18062892] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 12/20/2022]
Abstract
Many young people who engage in self-harm do not seek help from health services. For those that do, emergency departments (EDs) are a key point of contact. Substantial gaps remain in current knowledge related to young consumers’ experiences and views on optimal treatment of self-harm in the ED. In this study, semi-structured interviews were conducted with thirteen young people (Mage = 21.2 years), who were engaged with care at headspace early intervention centers and had presented to an ED with a self-inflicted physical injury. Participants were asked to describe their experience in the ED and the care they received. Data were analyzed thematically. Three inter-related themes were identified: 1. The ED was experienced through a lens of significant distress, 2. The ED environment and processes were counter-therapeutic, and 3. Staff were perceived to be disinterested, dismissive, and lacking in knowledge. The study highlights the overwhelmingly negative nature of participants’ experiences, and presents recommendations for service and practice improvements, such as the provision of staff training and increased aftercare.
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Amitai M, Ben Baruch R, Ben-Dor DH, Ben-Ami D, Katz M, Sagy R, Remez R, Liav N, Leibovich M, Apter A, Weizman A, Zalsman G. Predictors of Suicidal Behaviors during Hospitalization among Adolescents Admitted Due to Suicidal Behaviors: A 10-Year Retrospective Naturalistic Study. Arch Suicide Res 2020; 24:S202-S216. [PMID: 30856365 DOI: 10.1080/13811118.2019.1586610] [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] [Indexed: 10/27/2022]
Abstract
Objectives: Suicidality during hospitalization is a common phenomenon with potential devastating consequences. We attempted to identify risk factors for in-hospital suicidality in a high risk group of adolescent inpatients hospitalized for suicidal behaviors (SB). Methods: The database of a tertiary adolescent psychiatric ward was screened for patients hospitalized consecutively for SB during 2001-2010. Data on documented demographic, clinical, and behavioral risk factors were collected. Suicidal events during hospitalization were classified according to the Columbia Classification Algorithm of Suicide Assessment. Results: The sample included 122 inpatients (53% female) aged 10-19 (Mean=15.77, Standard Deviation=2.89) years admitted for SB. Thirty-seven youth (30%) exhibited SB during the hospitalization period (the "suicidal group"), ten of which attempted suicide while hospitalized. There were no significant differences in demographic and clinical parameters between the suicidal and the non-suicidal groups. Younger age, history of drug use and a history of non-suicidal self-injury (NSSI) were independent predictors of a SA during hospitalization. A previous SA added significant risk to SA during hospitalization only in the group that had a history of NSSI. Conclusions: A high risk of SB exists among adolescents hospitalized for suicidality. The risk assessment for SA during hospitalization should include age, history of drug use and previous SA combined with a history of NSSI. Future studies should expand the efforts to identify potential risk factors of SB during hospitalization in this unique high-risk group.
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Gardner W, Pajer K, Cloutier P, Zemek R, Currie L, Hatcher S, Colman I, Bell D, Gray C, Cappelli M, Duque DR, Lima I. Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:789-797. [PMID: 31184929 PMCID: PMC6882075 DOI: 10.1177/0706743719854070] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To document the rates of intentional self-harm and mental disorders among youths aged 13 to 17 years visiting Ontario emergency departments (EDs) from 2003-2017. METHODS This was a repeated cross-sectional observational design. Outcomes were rates of adolescents with (1) at least 1 self-harm ED visit and (2) a visit with a mental disorder code. RESULTS Rates of youths with self-harm visits fell 32% from 2.6/1000 in 2003 to 1.8 in 2009 but rose 135% to 4.2 by 2017. The slope of the trend in self-harm visits changed from -0.18 youths/1000/year (confidence interval [CI], -0.24 to -0.13) during 2003 to 2009 to 0.31 youths/1000/year (CI, 0.27 to 0.35) during 2009 to 2017 (P < 0.001). Rates of youths with mental health visits rose from 11.7/1000 in 2003 to 13.5 in 2009 (15%) and to 24.1 (78%) by 2017. The slope of mental health visits changed from 0.22 youths/1000/year (CI, 0.02 to 0.42) during 2003 to 2009 to 1.84 youths/1000/year (CI, 1.38 to 2.30) in 2009 to 2017 (P < 0.001). Females were more likely to have self-harm (P < 0.001) and mental health visits (P < 0.001). Rates of increase after 2009 were greater for females for both self-harm (P < 0.001) and mental health (P < 0.001). CONCLUSIONS Rates of adolescents with self-harm and mental health ED visits have increased since 2009, with greater increases among females. Research is required on the determinants of adolescents' self-harm and mental health ED visits and how they can be addressed in that setting. Sufficient treatment resources must be supplied to address increased demands for services.
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Affiliation(s)
- William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Pajer
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Cloutier
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Currie
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dayna Bell
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Gray
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daniel Rodriguez Duque
- Department of Epidemiology, Biostatistics, and Public Health, McGill University, Montreal, Quebec, Canada
| | - Isac Lima
- ICES Ottawa, Ottawa, Ontario, Canada
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Lee J, Bang YS, Min S, Ahn JS, Kim H, Cha YS, Park IS, Kim MH. Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults. BMC Psychiatry 2019; 19:231. [PMID: 31349782 PMCID: PMC6660711 DOI: 10.1186/s12888-019-2213-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults. METHODS This study included 149 children under the age of 18, and 1427 people in the age of 19-65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups. RESULTS In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults. CONCLUSION Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent's suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.
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Affiliation(s)
- Jinhee Lee
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Yeon Sik Bang
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Seongho Min
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Joung-Sook Ahn
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Hyun Kim
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong-Sung Cha
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Suk Park
- Yonsei Soul Psychiatric Clinic, Wonju, South Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea.
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Cozzi G, Barbi E. Facing somatic symptom disorder in the emergency department. J Paediatr Child Health 2019; 55:7-9. [PMID: 30288831 DOI: 10.1111/jpc.14246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
Somatic symptom disorder is a condition in which a patient's subjective report of physical symptoms is associated with distress; disruption of day-to-day functioning; or disproportionate thoughts, feelings and behaviours regarding the symptoms, whether or not they are associated with an identified medical condition. While somatic symptom disorder affects a considerable proportion of children and adolescents presenting to the emergency department (ED), it has not been well investigated in the ED literature, nor is there much formal training in, or guidelines for, how to care for affected patients in the ED. The aim of this paper is to highlight the historical clues commonly reported by these patients in order to try to help the emergency physicians recognise patients affected by a somatic symptom disorder. Adolescent age, the presence of daily subjective symptoms presenting daily for weeks or months, a long medical history record, an extensive diagnostic workup and, most of all, disproportionate functional impairment related to the symptoms are all features strongly suggestive of this disorder. Emergency physicians should become used to taking advantage of these clues to formulate a positive diagnosis of somatic symptom disorder according to the most recent diagnostic criteria. Emergency physicians have the unique opportunity to contribute to the correct diagnosis and treatment of these patients and to have a positive impact on their prognosis.
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Affiliation(s)
- Giorgio Cozzi
- Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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McCluskey CK, Allareddy V, Rampa S, Allareddy V, Rotta AT. Characterization of Suicide and Deliberate Self-Harm Among Children in the United States. Clin Pediatr (Phila) 2019; 58:66-72. [PMID: 30338709 DOI: 10.1177/0009922818806313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We analyzed data from the Nationwide Emergency Department Sample (NEDS) database for the years 2008 to 2013 to characterize deliberate self-harm among children and adolescents presenting to an emergency department (ED) in the United States. All ED visits for patients aged 19 years or younger involving any self-inflicted injuries were selected. We identified 594 658 ED visits involving self-harm. The majority of patients were female (65.8%), and between ages 16 and 19 years (62.6%). Most were treated and released from the ED (44.9%). The most common mechanisms involved injury by cutting/piercing instruments (26.4%) or poisoning by analgesics or antipyretics (21.5%). There was decrease in ED visits involving 16 to 19 year olds (-8%), and an increase in visits involving 13 to 15 year olds (+45%), 11 to 12 year olds (+94%), and 10 year olds or younger (16%). Our findings highlight a new vulnerable younger population at risk for self-inflicted injuries.
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Affiliation(s)
- Casey K McCluskey
- 1 UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Alexandre T Rotta
- 1 UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
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Grandclerc S, Spiers S, Spodenkiewicz M, Moro MR, Lachal J. The Quest for Meaning Around Self-Injurious and Suicidal Acts: A Qualitative Study Among Adolescent Girls. Front Psychiatry 2019; 10:190. [PMID: 31024356 PMCID: PMC6461024 DOI: 10.3389/fpsyt.2019.00190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/15/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Suicide and non-suicidal self-injury (NSSI) are major problems in adolescent psychiatry and share numerous clinical characteristics. The principal objective of this study is to describe the subjective experience of adolescent girls and young women who present NSSI and/or suicidal behaviors and to determine the common aspects and the specificities of each experience. Method: This exploratory study is based on a procedure that is qualitative, phenomenological, and inductive. The data were collected from two semi-structured interviews each of 18 girls and young women aged 12-21 years, who were receiving care from a psychiatrist specializing in adolescents and who at least once had harmed themselves by NSSI or attempted suicide, or both. The thematic data analysis was performed by applying the methods of interpretative phenomenological analysis. Results: The results are described around four superordinate themes: relationships with the self, with others/otherness, with the body, and with death; they are then subdivided into 13 themes. Several themes appeared common to both types of behavior, especially the relational dimension of self-harming acts. The process of separation-individuation seems complex for these youth. Conclusion: The results underline the relational aspects of the self-harming behavior (NSSI or suicidal) among adolescent girls. These aspects also appear to be expressed in the family sphere, the social sphere, in contact with peers, and also at a societal level when the community no longer addresses adolescents' difficulties. When the process of subjectification does not appear to reach completion, self-aggressive behavior is seen as an ultimate attempt to regain a feeling of autonomy.
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Affiliation(s)
- Salomé Grandclerc
- Maison de Solenn, MDA Cochin, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,CESP, Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Solene Spiers
- Service de Pédopsychiatrie, CHU de Caen, Caen, France.,UFR de Médecine, Université Caen Normandie, Caen, France.,Université Paris 13, Villetanneuse, France
| | - Michel Spodenkiewicz
- CESP, Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Pôle de Santé Mentale, CHU Sud Réunion, Saint-Pierre, France.,CEPOI EA 7388, UFR Santé, Université de la Réunion, Saint-Pierre, France
| | - Marie Rose Moro
- Maison de Solenn, MDA Cochin, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,CESP, Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Jonathan Lachal
- Maison de Solenn, MDA Cochin, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,CESP, Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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