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Hurst LE, Tengelitsch E, Bruni T, Lee J, Marcus S, Quigley J. Psychiatry Consultation in Primary Care: Examining Treatment Access for Adolescent Depression. J Adolesc Health 2024:S1054-139X(24)00409-9. [PMID: 39365233 DOI: 10.1016/j.jadohealth.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/24/2024] [Accepted: 08/20/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE Youth in the United States are experiencing mental health concerns at an unprecedented level. Child Psychiatry Access Programs offer an innovative approach to close the gap between the need for care and insufficient mental health workforce. This study examined whether primary care provider consultation with a Child Psychiatry Access Program, Michigan Clinical Consultation & Care (MC3), was associated with greater access to treatment for adolescents with moderate to severe depression symptoms. METHODS A retrospective chart review was conducted of primary care visits between 2017 and 2021 for adolescent patients with first-time positive scores on the Patient Health Questionnaire-9. Descriptive statistics and logistic regression were used to examine if patients whose primary care provider used MC3 psychiatric consultations had improved access to depression treatment compared to those who did not. RESULTS Four hundred seventy nine patients reported Patient Health Questionnaire-9 scores indicating moderate to severe depression symptoms. Compared to non-MC3 consult patients (n = 409), MC3 consult patients (n = 70) had higher odds of being prescribed antidepressant medications (odds ratio [OR], 2.16; 95% confidence interval [CI] [1.11-4.22], p = .05), 4 times higher odds of having a primary care follow-up visit to monitor depression symptoms (OR, 4.56, 95% CI [2.56-8.14], p < .001), and higher odds of accessing mental health therapy (OR, 2.14; 95% CI [1.13-4.05], p = .05). DISCUSSION Use of MC3 consultations was associated with increased utilization of evidence-based depression treatments including medication, therapy, and follow-up care. Greater adoption of models such as MC3 may increase the capacity for addressing mental health needs in children.
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Affiliation(s)
- Laura E Hurst
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | | | - Teryn Bruni
- Department of Psychology, University of Michigan, Ann Arbor, Michigan; Department of Psychology, Algoma University, Sault Sainte Marie, Ontario, Canada
| | - Joyce Lee
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Sheila Marcus
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Joanna Quigley
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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2
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Valente KD, Reilly C, Carvalho RM, Smith ML, Mula M, Wirrell EC, Wilmshurst JM, Jetté N, Brigo F, Kariuki SM, Fong CY, Wang YP, Polanczyk GV, Castanho V, Demarchi IG, Auvin S, Kerr M. Consensus-based recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy: A report from the Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy. Epilepsia 2024. [PMID: 39320421 DOI: 10.1111/epi.18116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024]
Abstract
The Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy (ILAE) aimed to develop recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy. The Task Force conducted a systematic review and identified two studies that assessed the accuracy of four screening measures for depression and anxiety symptoms compared with a psychiatric interview. Nine studies met the eligibility criteria for treatment of anxiety and depressive disorders or symptoms. The risk of bias and certainty of evidence were assessed. The evidence generated by this review followed by consensus where evidence was missing generated 47 recommendations. Those with a high level of agreement (≥80%) are summarized. Diagnosis: (1) Universal screening for anxiety and depression is recommended. Closer surveillance is recommended for children after 12 years, at higher risk (e.g., suicide-related behavior), with subthreshold symptoms, and experiencing seizure worsening or therapeutic modifications. (2) Multiple sources of ascertainment and a formal screening are recommended. Clinical interviews are recommended whenever possible. The healthcare provider must always explain that symptom recognition is essential to optimize treatment outcomes and reduce morbidity. (3) Questioning about the relationship between symptoms of anxiety or depression with seizure worsening/control and behavioral adverse effects of antiseizure medications is recommended. Treatment: (1) An individualized treatment plan is recommended. (2) For mild depression, active monitoring must be considered. (3) Referral to a mental health care provider must be considered for moderate to severe depression and anxiety. (4) Clinical care pathways must be developed. (5) Psychosocial interventions must be tailored and age-appropriate. (6) Healthcare providers must monitor children with epilepsy who are prescribed antidepressants, considering symptoms and functioning that may not improve simultaneously. (7) Caregiver education is essential to ensure treatment adherence. (8) A shared-care model involving all healthcare providers is recommended for children and adolescents with epilepsy and mental health disorders. We identified clinical decisions in the management of depression and anxiety that lack solid evidence and provide consensus-based guidance to address the care of children and adolescents with epilepsy.
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Affiliation(s)
- Kette D Valente
- Laboratory of Clinical Neurophysiology, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo (HCFMUSP), Sao Paulo, Brazil
- Laboratory of Medical Investigation-LIM 21-Faculty of Medicine, University of Sao Paulo (FMUSP), Sao Paulo, Brazil
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, UK
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rachel M Carvalho
- Laboratory of Clinical Neurophysiology, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo (HCFMUSP), Sao Paulo, Brazil
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marco Mula
- IMBE, St George's University of London and Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nathalie Jetté
- Department of Clinical Neurosciences and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuan-Pang Wang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Guilherme V Polanczyk
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Stéphane Auvin
- Université Paris-Cité, INSERM NeuroDiderot, Paris, France
- APHP, Robert Debré University Hospital, Pediatric Neurology Department, ERN EpiCARE Member, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Mike Kerr
- Institute of Psychological Medicine and Clinical Neurosciences Cardiff University, Cardiff, UK
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Thomas KC, Annis IE, deJong NA, Christian RB, Davis SA, Hughes PM, Prichard BA, Prichard JR, Allen PS, Gettinger JS, Morris DAN, Eaker KB. Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children. Psychiatr Serv 2024:appips20230639. [PMID: 39257315 DOI: 10.1176/appi.ps.20230639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care. METHODS Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period. Polypharmacy was defined as two or more psychotropic drug class prescriptions concurrently for ≥60 days. Psychotherapy was defined as receipt of any psychotherapy or adaptive behavior treatment. Neighborhood context (health, environment, education, and wealth) was measured with the Child Opportunity Index. Multilevel generalized linear mixed models with random intercept for census tracts were used to assess the associations between individual and neighborhood characteristics and psychotropic polypharmacy and psychotherapy. RESULTS Moderate (vs. low) child opportunity was associated with higher odds of polypharmacy (adjusted OR [AOR]=1.79, 95% CI=1.19-2.67). High (vs. low) child opportunity was associated with higher odds of psychotherapy (AOR=2.15, 95% CI=1.43-3.21). Black (vs. White) race (AOR=0.51, 95% CI=0.37-0.71) and Hispanic ethnicity (AOR=0.44, 95% CI=0.26-0.73) were associated with lower odds of polypharmacy. CONCLUSIONS Among high-need children, neighborhood Child Opportunity Index, race, and ethnicity were significantly associated with treatment outcomes in analyses adjusted for clinical factors. The findings underscore concerns about structural disparities and systemic racism and raise questions about access.
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Affiliation(s)
- Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Neal A deJong
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Robert B Christian
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Beth A Prichard
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Jason R Prichard
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Pamela S Allen
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Joshua S Gettinger
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - D'Jenne-Amal N Morris
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Kerri B Eaker
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
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Martínez-Vega R, Maduforo AN, Renzaho A, Alaazi DA, Dordunoo D, Tunde-Byass M, Unachukwu O, Atilola V, Boatswain-Kyte A, Maina G, Hamilton-Hinch BA, Massaquoi N, Salami A, Salami O. Scoping review on mental health standards for Black youth: identifying gaps and promoting equity in community, primary care, and educational settings. Child Adolesc Psychiatry Ment Health 2024; 18:113. [PMID: 39252127 PMCID: PMC11385802 DOI: 10.1186/s13034-024-00800-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. METHODS Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. RESULTS Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. CONCLUSIONS Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services.
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Affiliation(s)
- Ruth Martínez-Vega
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, Canada
| | - Aloysius Nwabugo Maduforo
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, Canada
| | - Andre Renzaho
- School of Medicine, Western Sydney University, David Pilgrim AvenueNSW2560, Campbelltown , Australia
| | - Dominic A Alaazi
- School of Health Studies, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Dzifa Dordunoo
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, VIC, Canada
| | - Modupe Tunde-Byass
- Temerty Faculty of Medicine, University of Toronto, 123 Edward Street, Suite 1200, Toronto, Canada
| | - Olutoyosi Unachukwu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, Canada
| | - Victoria Atilola
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, Canada
| | | | - Geoffrey Maina
- College of Nursing, University of Saskatchewan, 173-1061 Central Avenue, PrinceAlbert, Canada
| | - Barbara-Ann Hamilton-Hinch
- Dalhousie University, Nova Scotia. School of Health and Human Performance, 5981 University Avenue, Room 4210F, Halifax, Canada
| | - Notisha Massaquoi
- Department of Health and Society, University of Toronto, Scarborough, 246 Bloor Street W, Toronto, Canada
| | - Azeez Salami
- Alberta Health Services, 604 Main Street S, T4B 3K7, Airdrie, Alberta, Canada
| | - Oluwabukola Salami
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, Canada.
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Thangada MS, Kasoju R. A systematic review of suicide risk management strategies in primary care settings. Front Psychiatry 2024; 15:1440738. [PMID: 39286394 PMCID: PMC11403327 DOI: 10.3389/fpsyt.2024.1440738] [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: 05/31/2024] [Accepted: 07/29/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction and Objective Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts. Methodology A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized. Results Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance. Discussion Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.
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Affiliation(s)
| | - Rahul Kasoju
- Department of General Medicine, Sri Venkata Sai (SVS) Medical College, Mahbubnagar, TG, India
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6
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Chokroverty L. Depression Part 2: Treatment. Pediatr Rev 2024; 45:494-504. [PMID: 39217118 DOI: 10.1542/pir.2024-006479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 09/04/2024]
Abstract
Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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7
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Chokroverty L. Depression Part 1: Evaluation. Pediatr Rev 2024; 45:483-493. [PMID: 39217122 DOI: 10.1542/pir.2022-005688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 09/04/2024]
Abstract
By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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8
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Ruppe NM, Clawson AH, Nwankwo CN, Blair AL. Longitudinal Associations Between Depression and Religiosity/Spirituality Among Individuals with Asthma in the United States. JOURNAL OF RELIGION AND HEALTH 2024; 63:2963-2980. [PMID: 37665416 DOI: 10.1007/s10943-023-01903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
There is limited literature examining the longitudinal stability of depressive symptoms for individuals with asthma, or how religiosity/spirituality relates to depressive symptoms across time. The present study aimed to identify the stability of and the longitudinal associations between depressive symptoms and R/S across multiple developmental periods for adolesents with asthma (N = 998) within the United States. Depressive symptoms (βrange 0.33 - 0.60) and R/S (βrange 0.26 - 0.73) were stable across time, with some variability. A cross-lagged association demonstrated that use of R/S in young adulthood (Wave 3) was associated with decreased depressive symptoms in adulthood (β = -0.17, p < .001, CI - 0.25 - - 0.09, SE = 0.04). Use of R/S in adolescence (Wave 2) was predictive of increased depression in adulthood (β = 0.13, p < .001, CI 0.05 - 0.20, SE = 0.04). Results demonstrated differential relations between R/S and depressive symptoms across development, and highlight the potential importance of integrating conversations focused on R/S within healthcare settings, especially as R/S during young adulthood may buffer against or reduce depressive symptoms in adulthood.
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Affiliation(s)
- Nicole M Ruppe
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA.
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, DE, 19803, USA.
| | - Ashley H Clawson
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR, 72205, USA
| | - Cara N Nwankwo
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Alexandra L Blair
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
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Singh D, Schumacher HK, Pellegrino CA, Holmes BW, Garfield RL, Harder VS. Assessing Strengths and Well-Being in Primary Care for Adolescents With Mental Health and Substance Use Concerns. Clin Pediatr (Phila) 2024:99228241264769. [PMID: 39049161 DOI: 10.1177/00099228241264769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
As the COVID-19 pandemic highlighted gaps in meeting adolescent behavioral health needs, primary care providers (PCPs) were a locus for interventions to address adolescent mental health and substance use concerns. Strength-based approaches may support PCP promotion of positive behavioral health in adolescents, but competing priorities or other factors may inhibit their use. We analyzed health record review data from 31 primary care practices to assess utilization of strength-based approaches during the health supervision visit (HSV) for adolescents with and without behavioral health concerns. We found that most had strengths identified (78%) or well-being topics addressed (83%). However, adolescents screening positive for depression were 40% less likely to have strengths identified, whereas those screening positive for anxiety or substance use were 89% and 163%, respectively, more likely to have well-being topics addressed. Primary care providers may need support for integrating strength-based approaches when managing adolescents screening positive for depression.
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Affiliation(s)
- Deepinder Singh
- The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Heidi K Schumacher
- Vermont Child Health Improvement Program, Department of Pediatrics, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Christine A Pellegrino
- Vermont Child Health Improvement Program, Department of Pediatrics, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Breena W Holmes
- Vermont Child Health Improvement Program, Department of Pediatrics, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Rachel L Garfield
- Vermont Child Health Improvement Program, Department of Pediatrics, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Valerie S Harder
- Vermont Child Health Improvement Program, Department of Pediatrics, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
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10
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Myint MT, Yue H, Zalpuri I, Sharma N, Stewart C. Workforce Initiatives to Advance Health Equity and Diverse Representation. Child Adolesc Psychiatr Clin N Am 2024; 33:437-445. [PMID: 38823815 DOI: 10.1016/j.chc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.
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Affiliation(s)
- Myo Thwin Myint
- Tulane University, Children's Hospital New Orleans, 1430 Tulane Avenue, #8055, New Orleans, LA 70112, USA.
| | - Han Yue
- Tufts University, 800 Washington Street Pratt Building 2nd Floor, Boston, MA 02111, USA
| | - Isheeta Zalpuri
- Stanford University, 401 Quarry Road, Palo Alto, CA 94304, USA
| | - Neha Sharma
- Tufts University, 800 Washington Street Pratt Building 2nd Floor, Boston, MA 02111, USA
| | - Colin Stewart
- Georgetown University, 2115 Wisconsin Avenue Northwest, Washington, DC 20016, USA
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11
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Kodzo LD, Danso NAA, Budu JT, Akriti KB, Hussain A, Zhang R. Experience of psychosocial rehabilitation; perspectives of depressed adolescents. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02473-z. [PMID: 38809300 DOI: 10.1007/s00787-024-02473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
Given the multifaceted character of depression and its related symptoms, an adolescent living with it is at increased risk for a wide range of adverse events. This research aimed to understand and characterize the psychosocial rehabilitation experiences of depressed teenage participants in the Greater Accra Region of Ghana. A cross-sectional semi-structured interview design influenced by an interpretive phenomenological analysis (IPA) technique was adopted. We employed a nonprobability, purposeful sampling approach to recruit twenty-one adolescents (6 males, 15 females) diagnosed with depression from the community after one month of discharge from admission and undergoing psychosocial rehabilitation. Using separate interviews, we gathered and analyzed data using interpretive phenomenological analysis to produce themes and sub-themes. These were presented with the participants' direct quotations. We discovered that the perspectives of adolescents' psychosocial rehabilitation experience include hopelessness and suicide ideation, coping difficulties, undesirable attitudes from support networks, challenges related to school, and isolation. Participants suggested appropriate therapeutic environments, encouraging support systems, and the media's role in preventing and treating depression among young people as rehabilitation approaches that could assist adolescents to remain lucid for longer intervals. These results shed light on the tragic realities faced by depressed adolescents. There is an urgent need to put well-defined structures in place to aid their rehabilitation and develop coping strategies for a better life.
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Affiliation(s)
- Lalit Dzifa Kodzo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Nursing and Midwifery Training College, Central Region, Twifo Praso, Ghana
- School of International Education, Southern Medical University, Guangzhou, China
- Organization of African Academic Doctors (OAAD), Off Kamiti Road, Nairobi, Kenya
| | | | | | | | - Abid Hussain
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Ruixing Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
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12
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Doan TT, Hutton DW, Wright DR, Prosser LA. Estimating Transition Probabilities for Modeling Major Depression in Adolescents by Sex and Race or Ethnicity Combinations in the USA. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:375-390. [PMID: 38253972 DOI: 10.1007/s40258-024-00872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE About one-fifth of US adolescents experienced major depressive symptoms, but few studies have examined longitudinal trends of adolescents developing depression or recovering by demographic factors. We estimated new transition probability inputs, and then used them in a simulation model to project the epidemiologic burden and trajectory of depression of diverse adolescents by sex and race or ethnicity combinations. METHODS Transition probabilities were first derived using parametric survival analysis of data from the National Longitudinal Study of Adolescent to Adult Health and then calibrated to cross-sectional data from the National Survey on Drug Use and Health. We developed a cohort state-transition model to simulate age-specific depression outcomes of US adolescents. A hypothetical adolescent cohort was modeled from 12-22 years with annual transitions. Model outcomes included proportions of youth experiencing depression, recovery, or depression-free cases and were reported for a US adolescent population by sex, race or ethnicity, and sex and race or ethnicity combinations. RESULTS At 22 years of age, approximately 16% of adolescents had depression, 12% were in recovery, and 72% had never developed depression. Depression prevalence peaked around 16-17 years-old. Adolescents of multiracial or other race or ethnicity, White, American Indian or Alaska Native, and Hispanic, Latino, or Spanish descent were more likely to experience depression than other racial or ethnic groups. Depression trajectories generated by the model matched well with historical observational studies by sex and race or ethnicity, except for individuals from American Indian or Alaska Native and multiracial or other race or ethnicity backgrounds. CONCLUSIONS This study validated new transition probabilities for future use in decision models evaluating adolescent depression policies or interventions. Different sets of transition parameters by demographic factors (sex and race or ethnicity combinations) were generated to support future health equity research, including distributional cost-effectiveness analysis. Further data disaggregated with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability would be helpful to project accurate estimates for historically minoritized communities.
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Affiliation(s)
- Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, 3414 Fifth Avenue, 1st Floor, Pittsburgh, PA, 15213-3205, USA.
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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He Y, Tan X, Wang J, Wiley J, Huang Y, Ding H, Wang Q, Huang T, Sun M. Trust, discrimination and preference for shared decision-making in adolescents diagnosed with depression: Implications from Chinese mental health professionals. PATIENT EDUCATION AND COUNSELING 2024; 122:108137. [PMID: 38232674 DOI: 10.1016/j.pec.2024.108137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND While evidence suggests that the attitudes of healthcare providers toward medical decision-making in adolescents diagnosed with depression merit exploration, research on their preferences for Shared Decision-Making (SDM) and the factors affecting these preferences remains limited. OBJECTIVE To investigate Chinese mental health professionals' (MHPs) preferences for SDM in adolescents with depression and identify the relationships between their preference for SDM and trust and discrimination. METHODS A cross-sectional design was used in this study. Clinical Decision-making Style-Staff (CDMS-S) was applied to evaluate their preferences for SDM. Physician Trust in the Patient Scale (PTPS) was utilised to assess their trust in consumers. Social Distance Scale to Mental Illness (SDSMI) was utilised to measure their discrimination against people with mental illness. RESULTS A total of 581 MHPs were identified in China. MHPs rated their preference for participation in decision making (PD) as shared (1.89 ± 0.472), information (IN) as moderate (2.62 ± 0.682), and family involvement (FI) as high (3.13 ± 0.840). The preferences for three decision topics ranked from the highest to the lowest score were working-related decision (2.35 ± 0.681), general preferences in decision (1.82 ± 0.581) and medication-related decision (1.74 ± 0.826). The mean score of PTPS and SDSMI were 34.71 (SD=9.709) and 15.17 (SD=4.299), respectively. Logistic regression indicated that the preference for PD was associated with discrimination; the preference for IN was associated with trust, discrimination and SDM-related training experience; and the preference for FI was associated with both trust and discrimination. CONCLUSIONS While MHPs generally exhibit a favourable attitude toward SDM, this positivity is not universally observed across all contexts. There remains room for improvement in the willingness to co-develop medication regimens and share health information. Rational recognition of depression, and building trusting and friendly therapeutic relationships are key to promoting MHPs' preferences for SDM. PRACTICAL VALUE MHPs' preferences for SDM have a significant impact on SDM implementation, which will be promoted by implementing SDM-related training.
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Affiliation(s)
- Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Jianjian Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - James Wiley
- School of Nursing, University of California, San Francisco.
| | - Yuxin Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Hui Ding
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Qian Wang
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Tianhui Huang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China; School of Nursing, Changsha Medical University, 1501 Leifeng Avenue, Wangcheng district, Changsha, Hunan 410219, China.
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14
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Martinez DT. Managing major depressive disorder in adolescents in primary care. JAAPA 2024:01720610-990000000-00110. [PMID: 38595130 DOI: 10.1097/01.jaa.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT Major depressive disorder (MDD) remains a significant risk to adolescent health and well-being, recently amplified by the COVID-19 pandemic. Access to adolescent mental health care services remains challenging in many areas, resulting in many adolescents diagnosed with MDD remaining untreated. Primary care providers are becoming increasingly crucial in promptly diagnosing and treating this concern. Various clinical guidelines can support clinicians in developing strategies for screening, diagnosing, and managing a vulnerable population with MDD. Standardized screenings, algorithms, and treatment guidelines can help improve the quality of life and functional impairment of those with MDD.
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Affiliation(s)
- Don T Martinez
- Don T. Martinez, Jr., is an assistant professor in the PA program at Midwestern University in Downers Grove, Ill. The author has disclosed no potential conflicts of interest, financial or otherwise
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15
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Chua KP, Volerman A, Zhang J, Hua J, Conti RM. Antidepressant Dispensing to US Adolescents and Young Adults: 2016-2022. Pediatrics 2024; 153:e2023064245. [PMID: 38404197 PMCID: PMC10904889 DOI: 10.1542/peds.2023-064245] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Mental health worsened in adolescents and young adults after the coronavirus disease 2019 (COVID-19) outbreak in March 2020, but whether antidepressant dispensing to this population changed is unknown. METHODS We identified antidepressant prescriptions dispensed to US individuals aged 12 to 25 years from 2016 to 2022 using the IQVIA Longitudinal Prescription Database, an all-payer national database. The outcome was the monthly antidepressant dispensing rate, defined as the monthly number of individuals with ≥1 dispensed antidepressant prescription per 100 000 people. We fitted linear segmented regression models assessing for level or slope changes during March 2020 and conducted subgroup analyses by sex and age group. RESULTS Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased 66.3%, from 2575.9 to 4284.8. Before March 2020, this rate increased by 17.0 per month (95% confidence interval: 15.2 to 18.8). The COVID-19 outbreak was not associated with a level change but was associated with a slope increase of 10.8 per month (95% confidence interval: 4.9 to 16.7). The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand. In subgroup analyses, this rate increased 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively. In contrast, the outbreak was associated with a level decrease among males aged 12 to 17 years and was not associated with a level or slope change among males aged 18 to 25 years. CONCLUSIONS Antidepressant dispensing to adolescents and young adults was rising before the COVID-19 outbreak and rose 63.5% faster afterward. This change was driven by increased antidepressant dispensing to females and occurred despite decreased dispensing to male adolescents.
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Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Jason Zhang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Joanna Hua
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, Massachusetts
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16
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Melnyk BM. The evidence-based COPE program: Reducing the time between diagnosing and treating depression and anxiety in youth. Nurse Pract 2024; 49:40-47. [PMID: 38386473 PMCID: PMC10878455 DOI: 10.1097/01.npr.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT The soaring prevalence of depression and anxiety in children, teenagers, and young adults is now a public health epidemic, yet access to timely evidence-based mental health treatment is often lacking due to a severe shortage of mental health providers. This article provides an overview of the current state of depression and anxiety in children and adolescents as well as first-line evidence-based treatment. The Creating Opportunities for Personal Empowerment (COPE) program, a cognitive-behavioral skills-building intervention, is highlighted as an evidence-based intervention for timely treatment that can be delivered by NPs, physicians, and physician associates/assistants in primary care settings, school-based health centers, and chronic care clinics with reimbursement as well as in schools and universities as a preventive mental health intervention.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- Bernadette Mazurek Melnyk is creator of the COPE program and founder of COPE2Thrive, LLC. She is a globally recognized expert, speaker, author, and researcher in the areas of evidence-based practice, mental health and well-being, and intervention research
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17
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Slater H, AlZubi Y, Rezaeizadeh A, Hughes JL, Gorman A, Mayes TL, Elmore JS, Storch EA, Wakefield SM, Trivedi MH. Characterizing Measurement-Based Care in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01653-3. [PMID: 38340213 DOI: 10.1007/s10578-023-01653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/12/2024]
Abstract
Integration of measurement-based care (MBC) into clinical practice has shown promise in improving treatment outcomes for depression. Yet, without a gold standard measure of MBC, assessing fidelity to the MBC model across various clinical settings is difficult. A central goal of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) was to characterize MBC across the state of Texas through the development of a standardized tool to assess the use of MBC strategies when assessing depression, anxiety, side effects, and treatment adherence. A chart review of clinical visits indicated standardized depression measures (71.2%) and anxiety measures (64%) were being utilized across sites. The use of standardized measures to assess medication adherence and side effects was limited to less than six percent for both, with the majority utilizing clinical interviews to assess adherence and side effects; yet medication was changed in nearly half. Rates of utilization of standardized measures for participants with multiple MBC forms were similar to those who only provided one form.
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Affiliation(s)
- Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Yasmin AlZubi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Afsaneh Rezaeizadeh
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - April Gorman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA.
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18
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Peake E, Miller I, Flannery J, Chen L, Lake J, Padmanabhan A. Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2024; 26:e48467. [PMID: 38324367 PMCID: PMC10882470 DOI: 10.2196/48467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/28/2023] [Accepted: 10/25/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. OBJECTIVE This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. METHODS An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy-based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. RESULTS A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8≥10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean -5.08, 95% CI -6.72 to -3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; χ21=6.2; P=.01; false discovery rate-adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate-adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ≥5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. CONCLUSIONS There is initial evidence that a self-guided, cognitive behavioral therapy-based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. TRIAL REGISTRATION ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598.
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Affiliation(s)
- Emily Peake
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Ian Miller
- Limbix Health Inc, San Francisco, CA, United States
- Digital Medicine Society, Boston, MA, United States
| | - Jessica Flannery
- Limbix Health Inc, San Francisco, CA, United States
- Akili, Boston, MA, United States
| | - Lang Chen
- Neuroscience Unit, Santa Clara University, Santa Clara, CA, United States
| | - Jessica Lake
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Aarthi Padmanabhan
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
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19
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Bharthi K, Zuberi R, Maruf AA, Shaheen SM, McCloud R, Heintz M, McAusland L, Arnold PD, Bousman CA. Impact of Cytochrome P450 Genetic Variation on Patient-Reported Symptom Improvement and Side Effects Among Children and Adolescents Treated with Fluoxetine. J Child Adolesc Psychopharmacol 2024; 34:21-27. [PMID: 38377520 DOI: 10.1089/cap.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background: Clinical practice guidelines recommend the use of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), as a first-line pharmacotherapy for major depressive disorder (MDD) and obsessive compulsive disorder (OCD) in children and adolescents. However, response and tolerability to fluoxetine varies from child to child, which may in part, be a result of interindividual differences in fluoxetine metabolism. In this study, we examined whether genotype-predicted activity scores of cytochrome P450 enzymes were associated with patient-reported symptom improvement and side effects in children and adolescents treated with fluoxetine. Methods: Ninety children and adolescents aged 7-18 with a MDD or OCD diagnosis and a history of fluoxetine treatment were recruited from Western Canada. For each participant, fluoxetine dose and duration information were collected, as well as questions about adherence, side effects, and symptom improvement. DNA was extracted from a saliva sample and genotyped for CYP2D6, CYP2C19, CYP2C9, CYP3A4, and CYP3A5. Logistic regression models were fitted to assess the impact of activity scores on symptom improvement and side effects. Results: Increased CYP2D6 activity score was significantly associated with reduced odds of symptom improvement (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.23-0.91, p = 0.028) as well as a trend association with reduced side effects (OR = 0.49, 95% CI = 0.22-1.07, p = 0.072), after adjusting for age, sex, diagnosis, dose, duration, adherence, and activity scores of the other assessed CYP enzymes. No associations with symptom improvement or side effects were detected for the other CYP enzymes examined. Conclusions: Our results suggest that an increase in the genotype-predicted CYP2D6 activity score was associated with a decrease in the odds of reporting symptom improvement among children and adolescents treated with fluoxetine. These findings will contribute to future updates of pharmacogenetic-based SSRI prescribing guidelines and if replicated, could inform fluoxetine treatment in children and adolescents with MDD or OCD. Clinical Trial Registration: NCT04797364.
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Affiliation(s)
- Kanika Bharthi
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Rayyan Zuberi
- Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - Abdullah Al Maruf
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Sarker M Shaheen
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Ryden McCloud
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Madison Heintz
- Department of Medical Genetics, University of Calgary, Calgary, Canada
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Laina McAusland
- Department of Biological Sciences, University of Calgary, Calgary, Canada
- Department of Medical Genetics, University of Calgary, Calgary, Canada
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Paul D Arnold
- Department of Medical Genetics, University of Calgary, Calgary, Canada
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Chad A Bousman
- Department of Medical Genetics, University of Calgary, Calgary, Canada
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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Currie J, Kurdyak P, Zhang J. Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada. JOURNAL OF HEALTH ECONOMICS 2024; 93:102841. [PMID: 38113755 DOI: 10.1016/j.jhealeco.2023.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/27/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
We examine differences in the prescribing of psychiatric medications to lower-income and higher-income children in the Canadian province of Ontario using rich administrative data that includes diagnosis codes and physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that ideally should be prescribed to children only under narrowly proscribed circumstances. Lower-income children are also less likely to be prescribed SSRIs, the first-line treatment for depression and anxiety conditional on diagnosis. Hence, socioeconomic differences in the prescribing of psychotropic medications to children persist even in the context of universal public health insurance and universal drug coverage.
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Affiliation(s)
- Janet Currie
- Princeton University and Center for Health and Wellbeing, United States of America.
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21
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Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. Obstet Gynecol 2023; 142:1516-1533. [PMID: 37973069 DOI: 10.1097/aog.0000000000005426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To provide recommendations for the management of premenstrual syndrome and premenstrual dysphoric disorder, collectively referred to as premenstrual disorders, based on assessment of the evidence regarding the safety and efficacy of available treatment options. An overview of the epidemiology, pathophysiology, and diagnosis of premenstrual disorders also is included to provide readers with relevant background information and context for the clinical recommendations. TARGET POPULATION Reproductive-aged adults and adolescents with premenstrual symptoms. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on the following evidence-based treatment options for premenstrual disorders, with an acknowledgement that many patients may benefit from a multimodal approach that combines several interventions: pharmacologic agents (hormonal and nonhormonal), psychological counseling, complementary and alternative treatments, exercise and nutritional therapies, patient education and self-help strategies, and surgical management. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence. Based on review of extrapolated data from adult populations and expert consensus, it was determined that the recommendations also apply to adolescents, with a few exceptions that are noted in the Clinical Practice Guideline.
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Arora BK, Klein MJ, Yousif C, Khacheryan A, Walter HJ. Virtual Collaborative Behavioral Health Model in a Community Pediatric Network: Two-Year Outcomes. Clin Pediatr (Phila) 2023; 62:1414-1425. [PMID: 36988180 DOI: 10.1177/00099228231164478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys. Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged. This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.
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Affiliation(s)
- Bhavana Kumar Arora
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Margaret J Klein
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Heather J Walter
- Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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23
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Arruda W, Bélanger SA, Cohen JS, Hrycko S, Kawamura A, Lane M, Patriquin MJ, Korczak DJ. Promoting optimal mental health outcomes for children and youth. Paediatr Child Health 2023; 28:417-436. [PMID: 37885601 PMCID: PMC10599492 DOI: 10.1093/pch/pxad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/04/2022] [Indexed: 10/28/2023] Open
Abstract
While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g., access to a multidisciplinary team) or training to adequately identify or manage such problems. This joint statement describes the key roles and competencies required to assess and address child and youth mental health problems, and the factors that optimize outcomes in this age group. Evidence-informed guidance on screening for and discussing mental health concerns with young people and families is provided. Preventive and therapeutic interventions with demonstrated efficacy in community care settings are discussed. This foundational statement also focuses on the changes to medical education, health systems, and health policy that are needed to improve clinical practice and advocacy efforts in Canada, including appropriate remuneration models, stepped-care approaches, targeted government funding, and professional training and education.
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Affiliation(s)
- Wilma Arruda
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Stacey A Bélanger
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Janice S Cohen
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Sophia Hrycko
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Anne Kawamura
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Margo Lane
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Maria J Patriquin
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
| | - Daphne J Korczak
- Canadian Paediatric Society, Mental Health Task Force, with the Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario, Canada
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Arruda W, Bélanger SA, Cohen JS, Hrycko S, Kawamura A, Lane M, Patriquin MJ, Korczak DJ. La promotion de l'évolution optimale de la santé mentale chez les enfants et les adolescents. Paediatr Child Health 2023; 28:417-436. [PMID: 37885603 PMCID: PMC10599491 DOI: 10.1093/pch/pxad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/04/2022] [Indexed: 10/28/2023] Open
Abstract
Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle.
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Affiliation(s)
- Wilma Arruda
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Stacey A Bélanger
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Janice S Cohen
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Sophia Hrycko
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Anne Kawamura
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Margo Lane
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Maria J Patriquin
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
| | - Daphne J Korczak
- Société canadienne de pédiatrie, groupe de travail sur la santé mentale, conjointement avec l'Académie canadienne de psychiatrie de l'enfant de l'adolescent (Ontario) Canada
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25
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Ads MM, Keller AE. Whole-Body Health: Behavioral Approaches to Managing Depression in Primary Care. Pediatr Ann 2023; 52:e413-e417. [PMID: 37935392 DOI: 10.3928/19382359-20230906-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Pediatricians are typically the first people families trust to discuss their child's mental health concerns and are uniquely positioned to help address the problem of limited access to mental health services. This article covers brief behavioral interventions pediatricians can use to help treat mild depressive symptoms in the primary care context. Interventions include strategies for talking about depression (eg, validating experiences, normalizing difficulties, and emphasizing whole-body health), educating patients and their families (eg, psychoeducation about signs, symptoms, and treatment options), using brief behavioral and cognitive interventions (eg, behavioral activation and cognitive coping), and including a family and culturally sensitive approach to symptom management. [Pediatr Ann. 2023;52(11):e413-e417.].
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26
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He Y, Gan X, Li X, Wang T, Li J, Lei T, Huang Y, Liu R, Chen F, Teng T, Xie Y, Ouyang X, Zhou X. Sequenced treatment alternatives to relieve adolescent depression (STAR-AD): a multicentre open-label randomized controlled trial protocol. BMC Psychiatry 2023; 23:789. [PMID: 37891522 PMCID: PMC10612344 DOI: 10.1186/s12888-023-05221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is a prevalent mental health problem with low treatment success rates. Whether fluoxetine or fluoxetine combined with cognitive-behavioural therapy (CBT) is the more effective initial treatment for adolescent MDD remains controversial, and few studies have investigated whether treatment switching or augmentation is preferred when the initial treatment is not working well. METHODS We developed a multicentre open-label Sequential Multiple Assignment Randomized Trial (SMART) design, consisting of two phases lasting 8 weeks each. In phase 1 (at baseline), patients will be recruited and grouped in fluoxetine group or fluoxetine combined with CBT group by patient self-selection. In phase 2 (after 8 weeks of treatment), the nonresponders will be randomly assigned to six groups, in which participants will switch to sertraline, vortioxetine, or duloxetine or added aripiprazole, olanzapine, or lithium carbonate to fluoxetine. After the full 16 weeks of treatment, we will assess the long-term sustainability of the treatment effects by evaluating participants during their subsequent naturalistic treatment. The primary outcome will be the response rate, determined by the Children's Depression Rating Scale-Revised (CDRS-R). Secondary outcomes include the change in scores on the Beck Depression Inventory (BDI), the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and the Safe Assessment. DISCUSSION The results from this study will aid clinicians in making informed treatment selection decisions for adolescents with MDD. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov with Identifier: NCT05814640.
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Affiliation(s)
- Yuqian He
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xieyu Gan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ting Wang
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Tingting Lei
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yajie Huang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ruibing Liu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fei Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Teng Teng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yuxin Xie
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China.
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27
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Bloom PA, Pagliaccio D, Zhang J, Bauer CCC, Kyler M, Greene KD, Treves I, Morfini F, Durham K, Cherner R, Bajwa Z, Wool E, Olafsson V, Lee RF, Bidmead F, Cardona J, Kirshenbaum JS, Ghosh S, Hinds O, Wighton P, Galfalvy H, Simpson HB, Whitfield-Gabrieli S, Auerbach RP. Mindfulness-based real-time fMRI neurofeedback: a randomized controlled trial to optimize dosing for depressed adolescents. BMC Psychiatry 2023; 23:757. [PMID: 37848857 PMCID: PMC10580563 DOI: 10.1186/s12888-023-05223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Adolescence is characterized by a heightened vulnerability for Major Depressive Disorder (MDD) onset, and currently, treatments are only effective for roughly half of adolescents with MDD. Accordingly, novel interventions are urgently needed. This study aims to establish mindfulness-based real-time fMRI neurofeedback (mbNF) as a non-invasive approach to downregulate the default mode network (DMN) in order to decrease ruminatory processes and depressive symptoms. METHODS Adolescents (N = 90) with a current diagnosis of MDD ages 13-18-years-old will be randomized in a parallel group, two-arm, superiority trial to receive either 15 or 30 min of mbNF with a 1:1 allocation ratio. Real-time neurofeedback based on activation of the frontoparietal network (FPN) relative to the DMN will be displayed to participants via the movement of a ball on a computer screen while participants practice mindfulness in the scanner. We hypothesize that within-DMN (medial prefrontal cortex [mPFC] with posterior cingulate cortex [PCC]) functional connectivity will be reduced following mbNF (Aim 1: Target Engagement). Additionally, we hypothesize that participants in the 30-min mbNF condition will show greater reductions in within-DMN functional connectivity (Aim 2: Dosing Impact on Target Engagement). Aim 1 will analyze data from all participants as a single-group, and Aim 2 will leverage the randomized assignment to analyze data as a parallel-group trial. Secondary analyses will probe changes in depressive symptoms and rumination. DISCUSSION Results of this study will determine whether mbNF reduces functional connectivity within the DMN among adolescents with MDD, and critically, will identify the optimal dosing with respect to DMN modulation as well as reduction in depressive symptoms and rumination. TRIAL REGISTRATION This study has been registered with clinicaltrials.gov, most recently updated on July 6, 2023 (trial identifier: NCT05617495).
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Affiliation(s)
- Paul A Bloom
- Department of Psychiatry, Columbia University, New York, NY, USA.
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Jiahe Zhang
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Clemens C C Bauer
- Department of Psychology, Northeastern University, Boston, MA, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mia Kyler
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Keara D Greene
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Isaac Treves
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Katherine Durham
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Rachel Cherner
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Zia Bajwa
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Emma Wool
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Valur Olafsson
- Northeastern University Biomedical Imaging Center, Boston, MA, USA
| | - Ray F Lee
- Zuckerman Mind Brain and Behavior Institute, Columbia University, New York, NY, USA
| | - Fred Bidmead
- Northeastern University Biomedical Imaging Center, Boston, MA, USA
| | - Jonathan Cardona
- Zuckerman Mind Brain and Behavior Institute, Columbia University, New York, NY, USA
| | | | | | | | - Paul Wighton
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - H Blair Simpson
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Susan Whitfield-Gabrieli
- Department of Psychology, Northeastern University, Boston, MA, USA
- Northeastern University Biomedical Imaging Center, Boston, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
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28
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Shahidullah JD, Roberts H, Parkhurst J, Ballard R, Mautone JA, Carlson JS. State of the Evidence for Use of Psychotropic Medications in School-Age Youth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1454. [PMID: 37761415 PMCID: PMC10528957 DOI: 10.3390/children10091454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.
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Affiliation(s)
- Jeffrey D. Shahidullah
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Holly Roberts
- Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - John Parkhurst
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Rachel Ballard
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Jennifer A. Mautone
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USA;
| | - John S. Carlson
- Department of Counseling, Educational Psychology, & Special Education, Michigan State University, East Lansing, MI 48824, USA
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Cinko C, Thrasher A, Sawyer C, Kramer K, West S, Harris E. Using the Project ECHO Model to Increase Pediatric Primary Care Provider Confidence to Independently Treat Adolescent Depression. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:360-367. [PMID: 37280470 PMCID: PMC10243694 DOI: 10.1007/s40596-023-01800-x] [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: 10/31/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach. METHODS Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12 months pre- and post-course completion. RESULTS Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion. CONCLUSIONS These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.
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Affiliation(s)
- Courtney Cinko
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- University of Cincinnati, Cincinnati, OH, USA.
| | - Andrea Thrasher
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ciscily Sawyer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathy Kramer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara West
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily Harris
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
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Ruppe NM, Clawson AH, Ankney RL, Welch G, Mullins LL, Chaney JM. Depressive Symptom Trajectories Across Adolescence and Adulthood Among Individuals With Asthma. J Pediatr Psychol 2023; 48:572-582. [PMID: 37130344 PMCID: PMC10321385 DOI: 10.1093/jpepsy/jsad022] [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] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Individuals with asthma experience increased depressive symptoms, which is associated with deleterious health outcomes. No studies have examined depressive symptom trajectories among individuals with asthma despite increased risk. This study expanded prior literature by identifying the following: (1) depressive symptoms trajectories for individuals with and without asthma and (2) predictors of baseline levels and changes in symptoms across time for individuals with asthma. METHODS Adolescents with (N = 965) and without (N = 7,392) asthma self-reported on depressive symptoms (CESD-9) across development. Covariates included: demographics and persistence of asthma. Latent growth curve modeling (LGCM) was used to identify depressive symptom trajectories and their predictors. RESULTS A multigroup LCGM identified no significant differences between depressive symptom trajectories of individuals with and without asthma. Depressive symptoms followed a quadratic shape across time for individuals with asthma (Mintercept = 5.73, p < .00; Mlinear = -0.38,p < .001; Mquad = 0.03, p < .001), with a linear deceleration in depressive symptoms during adolescence and an acceleration of symptoms into adulthood. Next predictors of depressive trajectories among individuals with asthma were examined. Female sex (B = 0.58, p < .001), lower parent education (B = -0.57, p < .001), older age (B = 0.19, p < .001), and identifying as Black (B = 0.31, p = .04) were associated with greater baseline depressive symptoms. Older individuals exhibited faster linear symptom decelerations (B = -0.56, p < .001) and faster symptom accelerations (B = 0.73, p < .001). American Indian (AIAN) individuals exhibited faster linear symptom decelerations (B = -1.98, p = .005) and faster quadratic accelerations (B = 3.33, p = .007). DISCUSSION Our results suggest that the depressive symptom trajectories of individuals with asthma are curvilinear and similar to individuals without asthma. When examining predictors of depressive symptom trajectories for those with asthma, socioeconomic disadvantage and racial marginalization were associated with greater baseline depressive symptoms. Although AIAN youth demonstrated more favorable trajectories in adolescence, they also exhibited worse trajectories across young adulthood and adulthood. Findings suggest the need to better understand the impact of multilevel risk and protective factors on depressive symptoms trajectories for individuals with asthma, especially marginalized populations.
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Affiliation(s)
- Nicole M Ruppe
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
| | - Ashley H Clawson
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA
| | | | - Ginger Welch
- Department of Human Development and Family Science, Oklahoma State University, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
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32
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Kim C, Lee DY, Park J, Yang SJ, Tan EH, Alhambra DP, Lee YH, Lee S, Kim SJ, Lee J, Park RW, Shin Y. Safety outcomes of selective serotonin reuptake inhibitors in adolescent attention-deficit/hyperactivity disorder with comorbid depression: the ASSURE study. Psychol Med 2023; 53:4811-4819. [PMID: 36803587 DOI: 10.1017/s0033291723000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Attention deficit-hyperactivity disorder (ADHD) is related to depressive disorder, and adolescents with both present poor outcomes. However, evidence for the safety of concomitantly using a methylphenidate (MPH) and a selective serotonin reuptake inhibitor (SSRI) among adolescent ADHD patients is limited, a literature gap aimed to address through this investigation. METHODS We conducted a new-user cohort study using a nationwide claims database in South Korea. We identified a study population as adolescents who were diagnosed both ADHD and depressive disorder. MPH-only users were compared with patients who prescribed both a SSRI and a MPH. Fluoxetine and escitalopram users were also compared to find a preferable treatment option. Thirteen outcomes including neuropsychiatric, gastrointestinal, and other events were assessed, taking respiratory tract infection as a negative control outcome. We matched the study groups using a propensity score and used the Cox proportional hazard model to calculate the hazard ratio. Subgroup and sensitivity analyses were conducted in various epidemiologic settings. RESULTS The risks of all the outcomes between the MPH-only and SSRI groups were not significantly different. Regarding SSRI ingredients, the risk of tic disorder was significantly lower in the fluoxetine group than the escitalopram group [HR 0.43 (0.25-0.71)]. However, there was no significant difference in other outcomes between the fluoxetine and escitalopram groups. CONCLUSION The concomitant use of MPHs and SSRIs showed generally safe profiles in adolescent ADHD patients with depression. Most of the differences between fluoxetine and escitalopram, except those concerning tic disorder, were not significant.
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Affiliation(s)
- Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Su-Jin Yang
- Gwangju Smile Center for Crime victim support, Gwangju, South Korea
| | - Eng Hooi Tan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre of Statistics in Medicines, University of Oxford, Oxford, UK
| | - Daniel-Prieto Alhambra
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre of Statistics in Medicines, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yo Han Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea
| | - Sangha Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Seong-Ju Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Jeewon Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Yunmi Shin
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
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Zhang C, Zafari Z, Slejko JF, Camelo Castillo W, Reeves GM, dosReis S. Impact of different interventions on preventing suicide and suicide attempt among children and adolescents in the United States: a microsimulation model study. Front Psychiatry 2023; 14:1127852. [PMID: 37333921 PMCID: PMC10275605 DOI: 10.3389/fpsyt.2023.1127852] [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: 12/20/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Despite considerable investment in suicide prevention since 2001, there is limited evidence for the effect of suicide prevention interventions among children and adolescents. This study aimed to estimate the potential population impact of different interventions in preventing suicide-related behaviors in children and adolescents. Methods A microsimulation model study used data from national surveys and clinical trials to emulate the dynamic processes of developing depression and care-seeking behaviors among a US sample of children and adolescents. The simulation model examined the effect of four hypothetical suicide prevention interventions on preventing suicide and suicide attempt in children and adolescents as follows: (1) reduce untreated depression by 20, 50, and 80% through depression screening; (2) increase the proportion of acute-phase treatment completion to 90% (i.e., reduce treatment attrition); (3) suicide screening and treatment among the depressed individuals; and (4) suicide screening and treatment to 20, 50, and 80% of individuals in medical care settings. The model without any intervention simulated was the baseline. We estimated the difference in the suicide rate and risk of suicide attempts in children and adolescents between baseline and different interventions. Results No significant reduction in the suicide rate was observed for any of the interventions. A significant decrease in the risk of suicide attempt was observed for reducing untreated depression by 80%, and for suicide screening to individuals in medical settings as follows: 20% screened: -0.68% (95% credible interval (CI): -1.05%, -0.56%), 50% screened: -1.47% (95% CI: -2.00%, -1.34%), and 80% screened: -2.14% (95% CI: -2.48%, -2.08%). Combined with 90% completion of acute-phase treatment, the risk of suicide attempt changed by -0.33% (95% CI: -0.92%, 0.04%), -0.56% (95% CI: -1.06%, -0.17%), and -0.78% (95% CI: -1.29%, -0.40%) for reducing untreated depression by 20, 50, and 80%, respectively. Combined with suicide screening and treatment among the depressed, the risk of suicide attempt changed by -0.27% (95% CI: -0.dd%, -0.16%), -0.66% (95% CI: -0.90%, -0.46%), and -0.90% (95% CI: -1.10%, -0.69%) for reducing untreated depression by 20, 50, and 80%, respectively. Conclusion Reducing undertreatment (the untreated and dropout) of depression and suicide screening and treatment in medical care settings may be effective in preventing suicide-related behaviors in children and adolescents.
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Affiliation(s)
- Chengchen Zhang
- Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Julia F. Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Wendy Camelo Castillo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Gloria M. Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Susan dosReis
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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Coats T, Zurmehly J. Implementation of an Evidence-Based Clinical Guideline for Depression Screening of the Adolescent. Issues Ment Health Nurs 2023:1-10. [PMID: 37229904 DOI: 10.1080/01612840.2023.2205523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The evidence supports use of a depression screening tool to increase screening completion in the adolescent population. Clinical guidelines include use of the PHQ-9 in the adolescent population (ages 12-18). PHQ-9 screenings are currently lacking in this primary care setting. The aim of this Quality Improvement Project was to improve depression screening in a primary care practice setting located in a rural Appalachian health system. An educational offering with pretest and posttest surveys and a perceived competency scale are utilized. Focus is added to the process and guideline used to complete depression screening. As a result of the QI Project, posttest assessment of knowledge relating to educational offering increased, and use of the screening tool increased by 12.9%. The findings support the importance of education on primary care provider practice and depression screening of adolescents.
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Affiliation(s)
- Tracy Coats
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Joyce Zurmehly
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
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35
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Okubo R, Matsui K, Narukawa M. Factors Related to Placebo Response in Randomized, Double-Blind Clinical Trials of Antidepressants in Children and Adolescents: A Meta-regression Analysis. Clin Drug Investig 2023:10.1007/s40261-023-01273-8. [PMID: 37222973 DOI: 10.1007/s40261-023-01273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Many randomized clinical trials (RCTs) for antidepressants in children and adolescents have failed to demonstrate efficacy due to a high placebo response. The aim of this study was to identify the potential factors affecting placebo response using meta-regression analysis of RCTs for antidepressants in children and adolescents using the Children's Depressive Rating Scale-Revised (CDRS-R) as the outcome. METHODS PubMed and ClinicalTrials.gov were searched for randomized, double-blind, placebo-controlled trials of antidepressants for the acute treatment of major depressive disorder in children and adolescents. The outcome used in the present study was the mean change of the CDRS-R total score from baseline to the last assessment for the primary efficacy in the placebo arm. Potential factors related to the placebo response, such as study design, operational, and patient factors, were explored using meta-regression. RESULTS The analyses included 23 trials. On multivariable meta-regression, setting up a placebo lead-in period was significantly associated with a smaller placebo response in the CDRS-R. CONCLUSION Setting up a placebo lead-in period should be considered in future clinical trials of antidepressants in adolescents and children.
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Affiliation(s)
- Risa Okubo
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
| | - Kazuhiro Matsui
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
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36
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Lester TR, Herrmann JE, Bannett Y, Gardner RM, Feldman HM, Huffman LC. Anxiety and Depression Treatment in Primary Care Pediatrics. Pediatrics 2023; 151:e2022058846. [PMID: 37066669 PMCID: PMC10691450 DOI: 10.1542/peds.2022-058846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Primary care pediatricians (PCP) are often called on to manage child and adolescent anxiety and depression. The objective of this study was to describe PCP care practices around prescription of selective serotonin reuptake inhibitors (SSRI) for patients with anxiety and/or depression by using medical record review. METHODS We identified 1685 patients who had at least 1 visit with a diagnosis of anxiety and/or depression in a large primary care network and were prescribed an SSRI by a network PCP. We randomly selected 110 for chart review. We reviewed the visit when the SSRI was first prescribed (medication visit), immediately previous visit, and immediately subsequent visit. We abstracted rationale for prescribing medication, subspecialist involvement, referral for psychotherapy, and medication monitoring practices. RESULTS At the medication visit, in 82% (n = 90) of cases, PCPs documented reasons for starting an SSRI, most commonly clinical change (57%, n = 63). Thirty percent (n = 33) of patients had documented involvement of developmental-behavioral pediatrics or psychiatry subspecialists at 1 of the 3 visits reviewed. Thirty-three percent (n = 37) were referred to unspecified psychotherapy; 4% (n = 4) were referred specifically for cognitive behavioral therapy. Of 69 patients with a subsequent visit, 48% (n = 33) had documentation of monitoring for side effects. CONCLUSIONS When prescribing SSRIs for children with anxiety and/or depression, PCPs in this network documented appropriate indications for starting medication and prescribed without subspecialist involvement. Continuing medical education for PCPs who care for children with these conditions should include information about evidence-based psychotherapy and strategies for monitoring potential side effects.
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Affiliation(s)
- Talia R. Lester
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics
- Stanford School of Medicine, Palo Alto, California
| | | | - Yair Bannett
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics
- Stanford School of Medicine, Palo Alto, California
| | - Rebecca M. Gardner
- Stanford School of Medicine, Palo Alto, California
- Quantitative Science Unit, Department of Medicine
| | - Heidi M. Feldman
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics
- Stanford School of Medicine, Palo Alto, California
| | - Lynne C. Huffman
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics
- Stanford School of Medicine, Palo Alto, California
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Dalal M, Holcomb JM, Sundaresan D, Dutta A, Riobueno-Naylor A, Peloquin GD, Benheim TS, Jellinek M, Murphy JM. Identifying and responding to depression in adolescents in primary care: A quality improvement response. Clin Child Psychol Psychiatry 2023; 28:623-636. [PMID: 35642512 DOI: 10.1177/13591045221105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics (AAP) recommends adolescent depression screening and subsequent follow-up for those scoring at-risk. The current study assessed the outcomes of a Quality Improvement (QI) project that implemented these guidelines during annual well-child visits in a network of pediatric practices. This project used a two-stage screening process. First, adolescents were screened with the Pediatric Symptom Checklist (PSC-17). Second, adolescents who screened at-risk on the PSC-17 were asked to complete the Patient Health Questionnaire (PHQ-9). QI-participating providers received training on how to categorize the severity of their patient's depression based on PHQ-9 cut-off scores and clinical interview, and to implement and document appropriate options for follow-up. Patients in the QI group were significantly more likely to be screened with both the PSC-17 (93.8% vs. 89.1%, p < .001) and the PHQ-9 (54.8% vs. 16.4%, p < .001) compared to those in the non-QI group. Of the 80 adolescents in the QI group at-risk on the PSC-17 and with a completed PHQ-9, 65 (81.3%) received at least one type of referral for mental health, ranging from behavioral health services to lifestyle interventions. Findings support the feasibility of adolescent depression screening and referrals within pediatric primary care.
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Affiliation(s)
- Michelle Dalal
- Practice Research Network, Pediatrics Department, 486522Reliant Medical Group, Milford, MA, USA
- Department of Pediatrics, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Devi Sundaresan
- Practice Research Network, Pediatrics Department, 486522Reliant Medical Group, Milford, MA, USA
| | - Anamika Dutta
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Alexa Riobueno-Naylor
- Department of Counseling Psychology, 196058Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, USA
| | - Gabrielle D Peloquin
- Practice Research Network, Pediatrics Department, 486522Reliant Medical Group, Milford, MA, USA
| | - Talia S Benheim
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Michael Jellinek
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, 1811Harvard Medical School, Boston, MA, USA
| | - J Michael Murphy
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, 1811Harvard Medical School, Boston, MA, USA
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Chiauzzi E, Robinson A, Martin K, Petersen C, Wells N, Williams A, Gleason MM. A Relational Agent Intervention for Adolescents Seeking Mental Health Treatment: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44940. [PMID: 36867455 PMCID: PMC10024210 DOI: 10.2196/44940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Unmet pediatric mental health (MH) needs are growing as rates of pediatric depression and anxiety dramatically increase. Access to care is limited by multiple factors, including a shortage of clinicians trained in developmentally specific, evidence-based services. Novel approaches to MH care delivery, including technology-leveraged and readily accessible options, need to be evaluated in service of expanding evidence-based services to youths and their families. Preliminary evidence supports the use of Woebot, a relational agent that digitally delivers guided cognitive behavioral therapy (CBT) through a mobile app, for adults with MH concerns. However, no studies have evaluated the feasibility and acceptability of such app-delivered relational agents specifically for adolescents with depression and/or anxiety within an outpatient MH clinic, nor compared them to other MH support services. OBJECTIVE This paper describes the protocol for a randomized controlled trial evaluating the feasibility and acceptability of an investigational device, Woebot for Adolescents (W-GenZD), within an outpatient MH clinic for youths presenting with depression and/or anxiety. The study's secondary aim will compare the clinical outcomes of self-reported depressive symptoms with W-GenZD and a telehealth-delivered CBT-based skills group (CBT-group). Tertiary aims will evaluate additional clinical outcomes and therapeutic alliance between adolescents in W-GenZD and the CBT-group. METHODS Participants include youths aged 13-17 years with depression and/or anxiety seeking care from an outpatient MH clinic at a children's hospital. Eligible youths will have no recent safety concerns or complex comorbid clinical diagnoses; have no concurrent individual therapy; and, if on medications, are on stable doses, based on clinical screening and as well as study-specific criteria. RESULTS Recruitment began in May 2022. As of December 8, 2022, we have randomized 133 participants. CONCLUSIONS Establishing the feasibility and acceptability of W-GenZD within an outpatient MH clinical setting will add to the field's current understanding of the utility and implementation considerations of this MH care service modality. The study will also evaluate the noninferiority of W-GenZD against the CBT-group. Findings may also have implications for patients, families, and providers looking for additional MH support options for adolescents seeking help for their depression and/or anxiety. Such options expand the menu of supports for youths with lower-intensity needs as well as possibly reduce waitlists and optimize clinician deployment toward more severe cases. TRIAL REGISTRATION ClinicalTrials.gov NCT05372913; https://clinicaltrials.gov/ct2/show/NCT05372913. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44940.
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Affiliation(s)
| | | | - Kate Martin
- Woebot Health, San Francisco, CA, United States
| | - Carl Petersen
- Children's Hospital of The King's Daughters, Norfolk, VA, United States
| | - Nicole Wells
- Children's Hospital of The King's Daughters, Norfolk, VA, United States
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Courtwright SE, Jones J, Barton A, Peterson K, Eigen K, Feuerstein J, Pawa A, Pawa A, Northridge J, Pall H. Including Voices of Adolescents With Chronic Conditions in the Redesign of Children's Mental Health Systems: Implications for Resource Allocation. J Pediatr Health Care 2023. [PMID: 36863886 DOI: 10.1016/j.pedhc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Adolescents with chronic conditions have disparate mental health outcomes. This study aimed to explore the perspectives of adolescents with chronic conditions on mental health system redesign to improve outcomes. METHOD Within an interpretive phenomenological approach, semistructured interviews with 17 adolescents aged 10-20 years with chronic conditions were conducted. Purposive sampling and recruitment occurred at three ambulatory sites. Data were analyzed using inductive and deductive thematic analysis until information saturation was achieved. RESULTS Four themes were identified: (1) Brushed off: I need to be heard, (2) I need someone I can really talk to and trust, (3) They need to reach out to us. Check in on us, and (4) the school nurse is for physical illness only. DISCUSSION Mental health system redesign should be considered for adolescents with chronic conditions. The findings can inform future research to test innovative health care delivery models to reduce mental health disparities in this vulnerable population.
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Affiliation(s)
- Suzanne E Courtwright
- Suzanne E. Courtwright, Postdoctoral Research Fellow, College of Nursing, University of Colorado, Aurora, CO; Center for Healthcare Delivery Research and Innovations, Columbia University School of Nursing, New York, NY.
| | - Jacqueline Jones
- Jacqueline Jones, Professor of Nursing, Assistant Dean and PhD Program Director, College of Nursing, University of Colorado, Aurora, CO
| | - Amy Barton
- Amy Barton, Professor, Senior Associate Dean for Faculty and Students, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, College of Nursing, University of Colorado, Aurora, CO
| | - Kerry Peterson
- Kerry Peterson, Associate Professor, Specialty Director of the PMHNP program, University of Colorado, Aurora, CO
| | - Karen Eigen
- Karen Eigen, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatric Emergency Medicine Physician, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Feuerstein
- Jessica Feuerstein, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatrician, Departments of Emergency Medicine and Adolescent Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, and Pediatrician; Department of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anil Pawa
- Anil Pawa, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Section Chief, Primary Care Pediatrics, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
| | - Akhil Pawa
- Akhil Pawa, Research Assistant, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Research Assistant, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Northridge
- Jessica Northridge, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Section Chief, Adolescent Medicine, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Harpreet Pall
- Harpreet Pall, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Kanine RM, Bush ML, Davis M, Jones JD, Sbrilli MD, Young JF. Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training. Child Psychiatry Hum Dev 2023; 54:96-108. [PMID: 34379228 DOI: 10.1007/s10578-021-01222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/27/2023]
Abstract
This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.
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Affiliation(s)
- Rebecca M Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.
| | - Morgan L Bush
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa D Sbrilli
- Clinical-Community Psychology PhD Program, Department of Psychology, University of Illinois - Urbana Champaign, Champaign, IL, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Goryunov AV, Golubeva NI, Shushpanova OV. [Experience of clinical use of fluvoxamine for the treatment of comorbid depression in childhood and adolescence]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-21. [PMID: 38127696 DOI: 10.17116/jnevro202312311214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To identify the frequency of administration of fluvoxamine, to determine the main targets of the drug and the expediency of its use in depression of various genesis in children and adolescents. MATERIAL AND METHODS To assess the frequency of prescribing fluvoxamine, 195 medical histories of patients who were inpatients in the children's department of the Mental Health Research Center in 2023 were analyzed. To assess the dynamics of depression during treatment with fluvoxamine, a clinical group was formed of 12 patients aged 10 to 15 years (age 13.1±3.6 years) who received fluvoxamine for the treatment of depression with comorbid obsessive-compulsive and anxiety-phobic disorders. Clinical and psychopathological, psychometric (Hamilton Depression Rating Scale - HDRS) and statistical research methods were used. RESULTS In total, in 2023, fluvoxamine was received by 20% (n=37) of all inpatient patients of child age (from 7 to 16 years). All patients received combination therapy. The therapeutic targets were comorbid depressive, obsessive-compulsive and anxiety symptoms developing in the structure of nosologically heterogeneous states, with the dominance of schizophrenic spectrum disorders. Against the background of the use of the drug fluvoxamine for 4 weeks in the clinical group, there was a significant reduction in depressive symptoms on the HDRS. Adverse events during complex therapy were observed in 20% of patients, but were not severe, did not require discontinuation of therapy and were unreliably associated with the use of fluvoxamine. CONCLUSION The use of the fluvoxamine provides reduction of depressive symptoms within the framework of various nosologies, and is characterized by sufficient safety. The variety of therapeutic targets of the fluvoxamine, including antidepressant, anti-anxiety, cognitive effects, is certainly a significant advantage of the studied fluvoxamine for use in childhood.
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Mancini K, Myers BR, Pajek J, Ramirez L, Stancin T. Addressing Suicide Risk in Primary Care: Cost Savings Associated with Diverting Patients From Emergency Departments. J Dev Behav Pediatr 2023; 44:e19-e23. [PMID: 36563342 DOI: 10.1097/dbp.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Integrating behavioral health into primary care ambulatory clinics can improve management of patients presenting with suicidality in medical practices. To date, financial outcomes associated with managing suicidality in integrated care have not been documented. OBJECTIVE This study sought to evaluate both course of treatment (e.g., the patient is discharged home and referred to emergency departments [EDs]) and financial outcomes (e.g., cost to medical center) for patients presenting with suicidality in integrated pediatric primary care. METHODS Medical record review was conducted across a 6-month period. Demographics, course of treatment, and financial data were collected. Financial data were extracted using EPSi software using a cost accounting model. We documented the amount in dollars billed to the patient/insurance company and the amount reimbursed to the medical center and then calculated net margins associated with each course of treatment. RESULTS Participants were 103 youth (aged 7-24 years). The results demonstrate that the integrated model of care diverted 93% of participants from the ED and that the highlighted model of care yielded cost savings for the medical center. After reimbursement, patients seen in the ED for suicide evaluations cost the medical center an average of 16 times more than patients who were managed in the primary care setting. CONCLUSION The results document the magnitude of cost savings associated with an integrated care model for treating high-risk youth.
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Affiliation(s)
- Kathryn Mancini
- Case Western Reserve University School of Medicine and MetroHealth Medical Center, Cleveland, OH
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Liu M, Rossow KM, Maxwell-Horn AC, Saucier LA, Van Driest SL. Pediatric considerations for pharmacogenetic selective serotonin reuptake inhibitors clinical decision support. Pharmacotherapy 2022. [PMID: 36524442 DOI: 10.1002/phar.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/27/2022] [Accepted: 10/30/2022] [Indexed: 12/23/2022]
Abstract
Pharmacogenetic testing for psychiatry is growing at a rapid pace, with multiple sites utilizing results to help clinical decision-making. Genotype-guided dosing and drug selection have been implemented at several sites, including Vanderbilt University Medical Center, where clinical decision support (CDS) based on pharmacogenetic results went live for selective serotonin reuptake inhibitors in 2020 for both adult and pediatric patients. Effective and appropriate implementation of CYP2D6- and CYP2C19-guided CDS for the pediatric population requires consideration of the evidence for the pharmacogenetic associations, medication indications, and appropriate alternative therapies to be used when a pharmacogenetic contraindication is identified. In this article, we review these pediatric pharmacogenetic considerations for selective serotonin reuptake inhibitor CDS. We include a case study, the current literature supporting clinical recommendations, considerations when designing pediatric CDS, future implications, and examples of sertraline, (es)citalopram, paroxetine, and fluvoxamine alerts.
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Affiliation(s)
- Michelle Liu
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katelyn M Rossow
- Developmental-Behavioral Pediatrics, Norton Children's Development Center, Louisville, Kentucky, USA
| | - Angela C Maxwell-Horn
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leigh Ann Saucier
- Vanderbilt Institute for Clinical & Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara L Van Driest
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1559-1568. [PMID: 35174411 DOI: 10.1007/s00406-022-01385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I2 = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.
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Nicol G, Wang R, Graham S, Dodd S, Garbutt J. Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e40242. [PMID: 36413390 PMCID: PMC9683529 DOI: 10.2196/40242] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. OBJECTIVE In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. METHODS This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. RESULTS The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. CONCLUSIONS In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053.
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Affiliation(s)
- Ginger Nicol
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Ruoyun Wang
- Division of Allergy, Immunology & Pulmonology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States
| | - Sharon Graham
- Division of Allergy, Immunology & Pulmonology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States
| | - Sherry Dodd
- Division of Allergy, Immunology & Pulmonology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States
| | - Jane Garbutt
- Division of Allergy, Immunology & Pulmonology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States
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Harris K, Aguila Gonzalez A, Vuong N, Brown R, Ciccolari Micaldi S. Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State. Clin Pediatr (Phila) 2022; 62:441-448. [PMID: 36352499 DOI: 10.1177/00099228221136121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The need for mental health care for pediatric patients outstrips the supply, especially in states, like Kansas, that experience shortages of mental health professionals. Pediatric mental health care access programs, like KSKidsMAP (Kansas Kids Mental health Access Program), increase access to care by building competence and confidence in primary care physicians and clinicians (PCPs) through a statewide integrated system that includes a consultation line. This study is a secondary analysis of KSKidsMAP consultation Line inquiries regarding patients aged 0 to 21 years with mental and behavioral health concerns. The study employs a mixed-method approach with descriptive statistics and thematic analysis of inquiries. Five themes were identified: (1) pharmacotherapy, (2) diagnostic evaluation, (3) community resources, (4) psychotherapy, and (5) other. This study sheds light on PCPs needs and illustrates the importance of Pediatric Mental Health Care Access programs offering interprofessional expertise to consulting PCPs, allowing for expansion of pediatric mental illness care into the primary care setting.
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Affiliation(s)
- Kari Harris
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Amanda Aguila Gonzalez
- Department of Population Health, University of Kansas School of Medicine-Wichita, KS, USA
| | - Ngoc Vuong
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rachel Brown
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Susanna Ciccolari Micaldi
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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Tsujii T, Sakurai H, Takeuchi H, Suzuki T, Mimura M, Uchida H. Predictors of response to pharmacotherapy in children and adolescents with psychiatric disorders: A combined post hoc analysis of four clinical trial data. Neuropsychopharmacol Rep 2022; 42:516-520. [PMID: 36330567 PMCID: PMC9773749 DOI: 10.1002/npr2.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The prediction of response to pharmacotherapy has not been sufficiently explored in children and adolescents with psychiatric disorders, which was addressed in this study. METHODS Data from four double-blind, placebo-controlled studies (sertraline and fluvoxamine for anxiety disorders, risperidone for autistic disorder, and fluoxetine for major depressive disorder) in children and adolescents funded by the National Institute of Mental Health were used. The response was defined as a score of 1 or 2 on the Clinical Global Impression-Global Improvement (CGI-I) at the endpoint. Logistic regression analysis was performed to evaluate associations between response status and the following variables: sex, diagnosis, treatment allocation, and CGI-Severity of Illness (CGI-S) score at baseline. Moreover, the presence of early improvement (a score of ≤3 in the CGI-I) at Week 1 was added to the independent variables in an additional binary logistic regression analysis, using the data from two studies. RESULTS A total of 599 patients were included in the analysis. In the binary logistic regression analysis, active drug use (odds ratio [OR] = 8.64, P < 0.001) and female sex (OR = 1.89, P = 0.002) were significantly associated with treatment response. In the second binary logistic regression, the presence of early improvement in the CGI-I (OR = 3.47, P = 0.009), as well as active drug use (OR = 15.05, P < 0.001) and female sex (OR = 2.87, P = 0.016), were associated with subsequent responses. CONCLUSION Allocation to active drugs, female sex, and early improvement may predict treatment response to pharmacotherapy among children and adolescents with psychiatric disorders.
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Affiliation(s)
- Takashi Tsujii
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan,Department of PsychiatryAsaka HospitalFukushimaJapan
| | - Hitoshi Sakurai
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Hiroyoshi Takeuchi
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Takefumi Suzuki
- Department of NeuropsychiatryUniversity of Yamanashi Faculty of MedicineYamanashiJapan
| | - Masaru Mimura
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan,Geriatric Mental Health Program, Centre for Addiction and Mental HealthTorontoCanada
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Liu H, Wen Y, Liang X, Xu Y, Qiao D, Yang C, Han M, Li H, Ren T, Zhang X, Li G, Liu Z. Prefrontal cortex neural activity predicts reduction of non-suicidal self-injury in adolescents with major depressive disorder: An event related potential study. Front Neurosci 2022; 16:972870. [PMID: 36408379 PMCID: PMC9671107 DOI: 10.3389/fnins.2022.972870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) is common in adolescent MDD, which is also a risk factor for suicide. However, there is few research on biomarkers and predictors about treatment response of NSSI. The purpose of this study was to find the difference of P300 between adolescent MDD with NSSI and healthy controls, and to explore whether the baseline electrophysiological level can predict the change of NSSI after treatment. Methods We collected 62 first-episode drug-naïve MDD adolescents with NSSI (MDD with NSSI group) and 44 healthy controls (HC group). The demographic data, HAMD score, self-injury frequency and electrophysiological level of NSSI group and HC group were collected. The HAMD score, frequency of NSSI in was also collected after 8 weeks of antidepressant treatment. Results Compared to HC, the latency of the N2, P3a, and P3b components were significantly prolonged, whereas the amplitude of P3a and P3b were decreased in the MDD with NSSI group (P < 0.001). The frequency of self-injury decreased significantly after treatment (P < 0.001). Regression analysis showed that the amplitudes of P3b had a significant positive predictive effect on the rate of change of NSSI frequency after 8 weeks. Conclusion P3b at baseline can be used as potential predictor for the reduction of NSSI in adolescent MDD.
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