1
|
Hennefield L, Denton EG, Chen PG, Sheftall AH, Ayer L. Preteen Suicide Risk Screening in the Pediatric Outpatient Setting: A Clinical Pathway. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00065-X. [PMID: 38908827 DOI: 10.1016/j.jaclp.2024.06.003] [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] [Received: 08/28/2023] [Revised: 04/26/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
We are in a youth mental health crisis with unprecedented and staggeringly high rates of suicidal ideations and suicide behaviors in preteens. In the United States, 14.5% of children aged 9-10 have experienced suicidal thoughts and behaviors, including 1.3% with a suicide attempt. American Academy of Pediatrics guidelines call for universal suicide risk screening of youth aged 12 years and older during preventative health care visits and screening in preteens aged 8-11 years when clinically indicated. However, what constitutes a clinical indication at 8-11 years can be difficult to systematically detect, and pediatric practitioners may not be equipped with necessary age-specific assessment tools. This is compounded by the lack of emphasis on preteen suicide risk screening (and focus on adolescents), which leaves practitioners without age-appropriate resources to make clinical determinations for at-risk preteens. The objective of this project was to develop an evidence-informed suicide risk screening pathway for pediatric practitioners to implement with preteen patients in outpatient settings. Suicide risk assessment in younger children (<8 years) is also briefly addressed. We convened a group of researchers and practitioners with expertise in preadolescent suicide, pediatric medicine, behavioral health screening integration with primary care, and child development. They reviewed the empirical literature and existing practice guidelines to iterate on a multi-informant clinical suicide risk screening pathway for preteens that includes both caregivers and preteens in the screening process. We also developed tools and accompanying guidelines for a preteen suicide risk screening workflow and risk determination to aid practitioners in deciding who, when, and how to screen. Finally, we provide scripts for introducing suicide risk screening to caregivers and preteens and to discuss screening findings.
Collapse
Affiliation(s)
- Laura Hennefield
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
| | - Ellen-Ge Denton
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | | | - Arielle H Sheftall
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | | |
Collapse
|
2
|
Yardley HL, McTiernan EF, Lemanek KL. A Narrative Review of Depression and Suicide in Adolescent Females to Guide Assessment and Treatment Recommendations. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00222-5. [PMID: 38703944 DOI: 10.1016/j.jpag.2024.04.003] [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: 12/07/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
STUDY OBJECTIVE Suicide is a leading cause of death for adolescents. Medical professionals are increasingly being asked to screen for depressive symptoms and suicidal ideation with little training. The purpose of this paper is to review factors related to suicidal thoughts and actions, assessment of symptoms, and initial suggestions for treatment for medical providers. METHODS A literature review of risk and resilience factors, assessment measures, and treatment options for depression and suicidal ideation and behavior in adolescent females was conducted. RESULTS Given the higher risk of suicidal thoughts and depressive symptoms in adolescent females, accurate and thorough assessment of symptoms is recommended. CONCLUSION Medical providers should be aware of symptoms related to depression and suicidal ideation in order to provide more effective assessments. Recommendations for brief assessment measures that can be used in the clinic and possible first line treatments are provided.
Collapse
|
3
|
Sattler A, Dunn J, Albarran M, Berger C, Calugar A, Carper J, Chirravuri L, Jawad N, Zein M, McGovern M. Asynchronous Versus Synchronous Screening for Depression and Suicidality in a Primary Health Care System: Quality Improvement Study. JMIR Ment Health 2024; 11:e50192. [PMID: 38712997 PMCID: PMC11082433 DOI: 10.2196/50192] [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] [Received: 06/22/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite being a debilitating, costly, and potentially life-threatening condition, depression is often underdiagnosed and undertreated. Previsit Patient Health Questionnaire-9 (PHQ-9) may help primary care health systems identify symptoms of severe depression and prevent suicide through early intervention. Little is known about the impact of previsit web-based PHQ-9 on patient care and safety. Objective We aimed to investigate differences among patient characteristics and provider clinical responses for patients who complete a web-based (asynchronous) versus in-clinic (synchronous) PHQ-9. Methods This quality improvement study was conducted at 33 clinic sites across 2 health systems in Northern California from November 1, 2020, to May 31, 2021, and evaluated 1683 (0.9% of total PHQs completed) records of patients endorsing thoughts that they would be better off dead or of self-harm (question 9 in the PHQ-9) following the implementation of a depression screening program that included automated electronic previsit PHQ-9 distribution. Patient demographics and providers' clinical response (suicide risk assessment, triage nurse connection, medication management, electronic consultation with psychiatrist, and referral to social worker or psychiatrist) were compared for patients with asynchronous versus synchronous PHQ-9 completion. Results Of the 1683 patients (female: n=1071, 63.7%; non-Hispanic: n=1293, 76.8%; White: n=831, 49.4%), Hispanic and Latino patients were 40% less likely to complete a PHQ-9 asynchronously (odds ratio [OR] 0.6, 95% CI 0.45-0.8; P<.001). Patients with Medicare insurance were 36% (OR 0.64, 95% CI 0.51-0.79) less likely to complete a PHQ-9 asynchronously than patients with private insurance. Those with moderate to severe depression were 1.61 times more likely (95% CI 1.21-2.15; P=.001) to complete a PHQ-9 asynchronously than those with no or mild symptoms. Patients who completed a PHQ-9 asynchronously were twice as likely to complete a Columbia-Suicide Severity Rating Scale (OR 2.41, 95% CI 1.89-3.06; P<.001) and 77% less likely to receive a referral to psychiatry (OR 0.23, 95% CI 0.16-0.34; P<.001). Those who endorsed question 9 "more than half the days" (OR 1.62, 95% CI 1.06-2.48) and "nearly every day" (OR 2.38, 95% CI 1.38-4.12) were more likely to receive a referral to psychiatry than those who endorsed question 9 "several days" (P=.002). Conclusions Shifting depression screening from in-clinic to previsit led to a dramatic increase in PHQ-9 completion without sacrificing patient safety. Asynchronous PHQ-9 can decrease workload on frontline clinical team members, increase patient self-reporting, and elicit more intentional clinical responses from providers. Observed disparities will inform future improvement efforts.
Collapse
Affiliation(s)
- Amelia Sattler
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia Dunn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marleni Albarran
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Charlotte Berger
- Technology and Digital Solutions, Stanford Health Care, Palo Alto, CA, United States
| | - Ana Calugar
- Department of Quality, Stanford Health Care, Stanford, CA, United States
| | - John Carper
- University Healthcare Alliance, Stanford, CA, United States
| | | | - Nadine Jawad
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mira Zein
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mark McGovern
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| |
Collapse
|
4
|
Danzo S, Kuklinski MR, Sterling SA, Beck A, Braciszewski JM, Boggs J, Briney JS, Charvat-Aguilar N, Eisenberg N, Kaffl A, Kline-Simon A, Loree AM, Lyons VH, Morse EF, Morrison KM, Negusse R, Scheuer H. Anxiety, depression, and suicidal ideation among early adolescents during the COVID-19 pandemic. J Adolesc 2024. [PMID: 38678440 DOI: 10.1002/jad.12333] [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: 10/21/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Anxiety and depression are among the most common and debilitating psychiatric disorders affecting youth, with both related to increased suicide risk. While rates of youth anxiety and depression were increasing before the COVID-19 pandemic, the pandemic further negatively impacted adolescent mental health. Unfortunately, few studies have examined prevalence of these concerns among early adolescents (ages 10-13) longitudinally during the pandemic. METHOD The current study examined self-reported anxiety and depression symptoms, and suicidal ideation amongst a general pediatrics population of 11- to 13-year-olds (n = 623) from March through September 2020 (early-pandemic) and approximately 7 months later (September 2020 through May 2021; mid-pandemic). Paired samples proportions were used to examine changes in prevalence of moderate to severe anxiety, depression, and suicidal ideation from early- to mid-pandemic. RESULTS Results highlight high initial rates and stability in anxiety and suicidal ideation, as well as a significant increase in depression (42.9% increase; p < .05) among the full sample during the COVID-19 pandemic. Prevalance of concerns were greatest for females and Hispanic youth during the early-pandemic, and generally highest for females and Medicaid insured youth at mid-pandemic. DISCUSSION Results extend recent research and underscore the need for continued monitoring of mental health concerns across development for youth who grew up during the COVID-19 pandemic; highlighting the need for sustainable, effective, and accessible early detection, prevention, and intervention strategies. Improving these services is critical to support youth who experienced pandemic-related stressors, and to prepare for supporting youth during future disruptive and isolating events.
Collapse
Affiliation(s)
- Sarah Danzo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Margaret R Kuklinski
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Jennifer Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | - John S Briney
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
| | | | - Nicole Eisenberg
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
| | - Abnette Kaffl
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Andrea Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Vivian H Lyons
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
- Department of Psychiatry & Behavioral Sciences, Allies in Healthier Systems for Health & Abundance in Youth, University of Washington, Seattle, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, USA
| | - Erica F Morse
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | - Kristi M Morrison
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
| | - Rahel Negusse
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Hannah Scheuer
- School of Social Work, Social Development Research Group, University of Washington, Seattle, USA
| |
Collapse
|
5
|
Davis M, Jones JD, Schwartz KTG, Dysart G, So A, Young JF. Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening. J Pediatr Psychol 2024; 49:111-119. [PMID: 38001561 DOI: 10.1093/jpepsy/jsad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk. METHODS Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study. RESULTS While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino). CONCLUSIONS Findings can inform symptom monitoring and opportunities for prevention in primary care.
Collapse
Affiliation(s)
- Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Clinical Futures, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
| | - Karen T G Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Gillian Dysart
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Amy So
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
| |
Collapse
|
6
|
Bruni T, Smith S, Quigley J, Koval E, LaLonde L, Maragakis A, Kilbourne AM, King C, Orringer K, Lee JM. Real-World Depression Screening Practices Among Primary Care Providers Across Patient-Level and Provider-Level Characteristics. Clin Pediatr (Phila) 2024:99228231223782. [PMID: 38279838 PMCID: PMC11282173 DOI: 10.1177/00099228231223782] [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] [Indexed: 01/29/2024]
Abstract
This study examined primary care provider (PCP) alignment with guideline-based care for adolescent depression screening and identified factors associated with post-screening responses. A retrospective chart review was conducted across 17 primary care clinics. Logistical regressions were estimated across provider specialties, sociodemographic factors, and patient clinical histories. Significant differences in follow-up and identification of depression were found among patients with more severe depression presentation. Follow-up screening was also more likely to be completed among patients with private insurance and less likely to occur among Black patients. Patients with significant mental health history of a mood concern, history of being prescribed psychotropic medication, were currently on medications at the time of the screening, or had a history of an internal mental health referral had a higher predicted probability of being identified as depressed on the patient problem list.
Collapse
Affiliation(s)
- Teryn Bruni
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, Algoma University, Sault Ste., Marie, ON, Canada
| | - Shawna Smith
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joanna Quigley
- Child & Adolescent Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Leah LaLonde
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | | | - Amy M. Kilbourne
- Department of Psychology, The American College of Greece, Athens, Greece
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cheryl King
- Child & Adolescent Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Kelly Orringer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Busby DR, Hughes JL, Walters M, Ihediwa A, Adeniran M, Goodman L, Mayes TL. Measurement Choices for Youth Suicidality. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01627-5. [PMID: 38147138 DOI: 10.1007/s10578-023-01627-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/27/2023]
Abstract
Suicide is among the leading causes of death among individuals ages 10-24, making suicidal thoughts and behaviors (STBs) a serious public health crisis among youth. Suicide risk screening and assessment are vital to addressing this public health crisis. In fact, many youths that screen positive for suicidal ideation do not have known mental health concerns and would have been missed if not asked directly. Medical settings are an optimal setting to detect suicidality early and provide appropriate follow-up monitoring and care as needed. To support effective and efficient screening and assessment of suicidal thoughts and behaviors, providers must choose measures with both strong psychometric properties and clinical utility. While measurement of STBs can vary across health settings, suicide risk screening and assessment typically involves gathering information about current suicidal ideation, suicidal behaviors, and suicidal plans via self-report questionnaires, clinical interviews, and/or computerized adaptive screens. In alignment with measurement-based care efforts, the current manuscript will provide a scoping review of measures of youth suicidal ideation, behavior, plans, and their risk factors. Specifically, the psychometric properties, clinical utility, and other key considerations for screening and assessment of adolescent suicide risk are discussed.
Collapse
Affiliation(s)
- Danielle R Busby
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA.
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, College of Medicine, and the Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mallory Walters
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Adannaya Ihediwa
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Michel Adeniran
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Lynnel Goodman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
8
|
Esposito J, Davis M, Boyd RC. Suicide Prevention in Pediatric Health Care Settings. Pediatr Clin North Am 2023; 70:1115-1124. [PMID: 37865434 DOI: 10.1016/j.pcl.2023.06.008] [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: 10/23/2023]
Abstract
Given recent trends demonstrating increased suicide risk among youth, particularly those from minoritized populations, youth suicide is a major public health concern. Evidence-based practices for the identification and management of youth suicide risk have been developed, yet many challenges exist to implementing them routinely in health care settings. Suggestions for leveraging publicly available resources, gathering input from a range of stakeholders to inform implementation, and enhancing multidisciplinary collaboration are provided with the aim of offering tangible steps toward addressing the youth suicide crisis.
Collapse
Affiliation(s)
- Jeremy Esposito
- Division of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA; Department of PolicyLab, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA
| | - Rhonda C Boyd
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA; Department of PolicyLab, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
9
|
Sarlo GL, Haughton T, Rizakos E, Merwin S, Havens KA, Pasupuleti A, Gaillard WD, Berl MM. Comparison of psychosocial screeners in an epilepsy clinic. Epilepsy Behav 2023; 148:109452. [PMID: 37797485 PMCID: PMC10842982 DOI: 10.1016/j.yebeh.2023.109452] [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: 05/17/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
Screenings are recommended for co-occurring conditions in pediatric epilepsy. However, there is limited research regarding which screener to implement in the clinic. This study aimed to compare different screening measures for attention-deficit/hyperactivity disorder (ADHD) and emotional concerns in a pediatric epilepsy population during a routine neurology clinic visit. Fifty (22%) of 226 contacted parents of children with epilepsy ages 5-17 years old agreed to participate. Screening measures included the Strengths and Difficulties Questionnaire (SDQ; Hyperactivity/Inattention (ADHD), Emotional Problems (E) subscales), the Pediatric Quality of Life Inventory Epilepsy Module (PedsQL-EM; Executive Functioning (EF), Mood/Behavior (M/B) subscales), and the ADHD Rating Scale (ADHD-RS). Analyses comparing measures included Chi Square, Pearson's correlation, and agreement statistics (Cohen's kappa, overall agreement). Consistent with prior literature, positive screening rates ranged from 40% to 72% for ADHD concerns and 38% to 46% for emotional concerns. Agreement between measures ranged from fair to substantial, with the highest agreement (85%; κ = 0.70) between the SDQ-E and PedsQL-EM-M/B. Although all measures rendered positive screens within expected rates, there are differences among the measures that inform screening measure selection.
Collapse
Affiliation(s)
- Gabrielle L Sarlo
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States
| | - Taylor Haughton
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Eleni Rizakos
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Stephanie Merwin
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Kathryn A Havens
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Archana Pasupuleti
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - William D Gaillard
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Madison M Berl
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States.
| |
Collapse
|
10
|
Hilliard M, Parkhurst JT. Suicide Risk Assessment and Safety Planning in Pediatric Primary Care. Pediatr Ann 2023; 52:e422-e425. [PMID: 37935394 DOI: 10.3928/19382359-20230906-05] [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
Suicidal thoughts and behavior are an increasing concern for youth. Pediatricians can prevent youth suicide through a stepwise process of screening, risk assessment, and safety planning incorporated into their practice. This article describes practical steps for pediatric clinicians to effectively detect and assess risks associated with suicidal thoughts and behaviors in youth while concurrently providing effective intervention. [Pediatr Ann. 2023;52(11):e422-e425.].
Collapse
|
11
|
Kenny J, Kelsay K, Bunik M, Xiong S, Millar A, Talmi A. Addressing Adolescent Suicidality in Pediatric Primary Care. J Dev Behav Pediatr 2023; 44:e527-e535. [PMID: 37796627 DOI: 10.1097/dbp.0000000000001217] [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: 09/09/2022] [Accepted: 08/01/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents. METHODS A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic. RESULTS Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health ( r = 0.24) and family navigators ( r = 0.26) and BHCs conducting a risk assessment ( r = 0.24), completing a safety plan ( r = 0.21), involving caregivers ( r = 0.29), sending the adolescent to the emergency department ( r = 0.28), and referring to family navigators ( r = 0.21; all p values < 0.05). CONCLUSION The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.
Collapse
Affiliation(s)
- Jessica Kenny
- Children's Hospital Colorado, Aurora, CO
- Division of Child and Adolescents, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO; and
| | - Kimberly Kelsay
- Children's Hospital Colorado, Aurora, CO
- Division of Child and Adolescents, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO; and
| | - Maya Bunik
- Children's Hospital Colorado, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Shengh Xiong
- Division of Child and Adolescents, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO; and
| | - Amanda Millar
- Division of Child and Adolescents, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO; and
| | - Ayelet Talmi
- Children's Hospital Colorado, Aurora, CO
- Division of Child and Adolescents, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO; and
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
12
|
Manning A, Weingard M, Fabricius J, French A, Sendak M, Davis N. Be ExPeRT (Behavioral Health Expansion in Pediatric Residency Training): A Case-Based Seminar. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11326. [PMID: 37534018 PMCID: PMC10392710 DOI: 10.15766/mep_2374-8265.11326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/08/2023] [Indexed: 08/04/2023]
Abstract
Introduction Pediatric residents report behavioral or mental health (B/MH) assessment and treatment as a training gap and often feel ill-equipped to address these issues in clinical practice. We developed a novel interactive training program to improve resident confidence in managing common pediatric B/MH conditions. Methods The Be ExPeRT curriculum comprised a half-day interactive seminar on attention deficit hyperactivity disorder, anxiety, depression, and suicidality followed by monthly case-based discussions. Content included didactic material, role-play, and case discussion. The training was optional and open to pediatric or combined medicine-pediatrics trainees. Results Twenty-three residents (70% female) participated in four separate seminars over 2 years. Of the participants attending the seminars, 17 (74%) completed the presurvey, and 16 (70%) completed the postsurvey. Statistically significant improvement was noted in comfort treating major depressive disorder (41% pre, 94% post, p = .002), suicide risk (29% pre, 94% post, p < .001), and anxiety (24% pre, 94% post, p < .001) following program participation. Twelve (75%) of the 16 participants completing the survey rated the training in the top 5%-10% with respect to other resident learning experiences. Discussion We developed this curriculum to enhance trainee knowledge and comfort in addressing common pediatric B/MH conditions in primary care. Significant improvement was noted in self-reported comfort in treating major depressive disorder, suicide risk, and anxiety, and the program was well received. The curriculum can be adapted for use in any training program for primary care providers to provide B/MH education that may be lacking or supplement existing programming.
Collapse
Affiliation(s)
- Alison Manning
- Assistant Professor and Clinician Educator, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | - Matthew Weingard
- Assistant Professor, Division of Pediatric Behavioral Health, Department of Pediatrics, University of Utah and Intermountain Primary Children's Hospital
| | - Jacqueline Fabricius
- Pediatric Rheumatology Fellow, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Alexis French
- Medical Instructor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Mya Sendak
- Consulting Associate, Department of Pediatrics, Duke University School of Medicine
| | - Naomi Davis
- Assistant Professor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| |
Collapse
|
13
|
Karcher NR, Hicks R, Schiffman J, Asarnow JR, Calkins ME, Dauberman JL, Garrett CD, Koli RL, Larrauri CA, Loewy RL, McGough CA, Murphy JM, Niendam TA, Roaten K, Rodriguez J, Staglin BK, Wissow L, Woodberry KA, Young JF, Gur RE, Bearden CE, Barch DM. Youth Mental Health Screening and Linkage to Care. Psychiatr Serv 2023; 74:727-736. [PMID: 36695011 PMCID: PMC10329990 DOI: 10.1176/appi.ps.202200008] [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] [Indexed: 01/26/2023]
Abstract
One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.
Collapse
Affiliation(s)
- Nicole R. Karcher
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | | | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, CA
| | - Joan R. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Judith L. Dauberman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Chantel D. Garrett
- Department of Health Services, Strong 365, University of Washington, Seattle, WA
| | - Roshni L. Koli
- Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | | | - Rachel L. Loewy
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - J. Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Kimberly Roaten
- Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Rodriguez
- Student Support & Health Services, Sacramento City Unified School District, Sacramento, CA
| | | | - Lawrence Wissow
- Department of Psychiatry, University of Washington, Seattle, WA
| | - Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, ME
- Department of Psychiatry, Tufts School of Medicine, Boston, MA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
- Departments of Psychological & Brain Sciences and Radiology, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
14
|
Schmiedehaus E, Snyder E, Perrotte J, Deason R, Howard K, Cordaro M. The Ongoing Mental Health Plight of Depressed College Students: Clinical Recommendations and the Importance of Early Screening and Detection. Issues Ment Health Nurs 2023:1-9. [PMID: 37279399 DOI: 10.1080/01612840.2023.2215866] [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: 06/08/2023]
Abstract
The COVID-19 pandemic disrupted the lives of college students. The psychological distress from the pandemic increased risk for provisional rates of Major Depression Disorder (MDD) during an already crucial developmental period. Using an online survey, participants were assessed for a provisional diagnosis of MDD using a validated screening tool, along with Generalized Anxiety Disorder (GAD) and psychosocial correlates. Findings showed a significant increase in the prevalence of MDD, and significant differences in social support, loneliness, substance use, GAD and suicidality were identified. Early screening and detection for potential MDD symptoms can reduce the severity, duration, and reoccurrence of future MDD episodes for college students.
Collapse
Affiliation(s)
- Evan Schmiedehaus
- Department of Philosophy, Texas State University, San Marcos, TX, USA
| | - Ethan Snyder
- Department of Biology, Texas State University, San Marcos, TX, USA
| | - Jessica Perrotte
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Rebecca Deason
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Krista Howard
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Millie Cordaro
- Department of Psychology, Texas State University, San Marcos, TX, USA
| |
Collapse
|
15
|
Bridge JA, Birmaher B, Brent DA. The Case for Universal Screening for Suicidal Risk in Adolescents. Pediatrics 2023; 151:e2022061093. [PMID: 37190959 PMCID: PMC10233732 DOI: 10.1542/peds.2022-061093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| |
Collapse
|
16
|
Hughes JL, Horowitz LM, Ackerman JP, Adrian MC, Campo JV, Bridge JA. Suicide in young people: screening, risk assessment, and intervention. BMJ 2023; 381:e070630. [PMID: 37094838 DOI: 10.1136/bmj-2022-070630] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
Collapse
Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institutes of Mental Health, NIH, Bethesda, MD, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH, USA
| |
Collapse
|
17
|
Horowitz LM, Ryan PC, Wei AX, Boudreaux ED, Ackerman JP, Bridge JA. Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:145-151. [PMID: 37201144 PMCID: PMC10172561 DOI: 10.1176/appi.focus.20220086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.
Collapse
Affiliation(s)
- Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Patrick C Ryan
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - August X Wei
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Edwin D Boudreaux
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - John P Ackerman
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Jeffrey A Bridge
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| |
Collapse
|
18
|
Suicide Preventive Interventions and Knowledge. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:178-179. [PMID: 37201137 PMCID: PMC10172550 DOI: 10.1176/appi.focus.23021002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
|
19
|
Christensen M, Fontanella CA, Campo JV, Culp SL. How can social workers facilitate suicide prevention in primary care? Findings from a national survey of primary care physicians. SOCIAL WORK IN HEALTH CARE 2023; 62:107-120. [PMID: 36946209 DOI: 10.1080/00981389.2023.2193227] [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: 11/17/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
There are currently no national data regarding U.S. Primary Care Physicians' (PCPs') suicide screening practices. This study surveyed 302 U.S. PCPs about their current suicide screening practices to identify service gaps and intervention points for social workers. Although one-third of PCPs reported providing screening and safety planning, few were using evidence-based tools. Factors that increased the likelihood of routine screening were belief in the importance of screening (p < .01), time (p < .01), and access to co-located behavioral health (p < .01). Findings support the role of social workers in primary care and suggest areas for training and collaboration.
Collapse
Affiliation(s)
- Mary Christensen
- West Virginia University School of Social Work, Morgantown, West Virginia, USA
| | | | - John V Campo
- Department is Psychiatry and Behavioral Sciences, The Johns Hopkins University; Kennedy Krieger Institute, Baltimore, MD, USA
| | - Stacey L Culp
- Department of Psychiatry, The Ohio State University College of Medicine, USA
| |
Collapse
|
20
|
Chavez B, Sullivan J, Portela P. Improving Adolescent Depression in Primary Care: A Quality Improvement Initiative. J Nurse Pract 2023; 19:104503. [PMID: 36721626 PMCID: PMC9881523 DOI: 10.1016/j.nurpra.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The coronavirus disease 2019 pandemic has exacerbated and increased the prevalence of depression in adolescents. There is significant evidence supporting best practices for treating adolescent depression; yet, many adolescents remain unidentified or untreated by their primary care provider. For this quality improvement initiative, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were implemented in a primary care setting. After GLAD-PC implementation, 90% of participants identified as having depression received an intervention compared with 60% of patients in the baseline group. The results showed that implementing GLAD-PC led to a significant increase in the treatment of adolescent depression in primary care.
Collapse
|
21
|
Kim HJ, Kim S, Son Y, Youn I, Lee K. Reliability and Validity of the Korean Version of the Ask Suicide-Screening Questions (ASQ). J Korean Med Sci 2023; 38:e41. [PMID: 36786085 PMCID: PMC9925327 DOI: 10.3346/jkms.2023.38.e41] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Ask Suicide-Screening Questions (ASQ) tool is a simple suicide screening tool developed to screen patient suicide risk (SR). The purpose of this study was to verify the reliability and validity of the ASQ tool in hospitalized patients. METHODS The internal consistency and test-retest reliability of the South Korean version of the ASQ tool were verified in 99 hospitalized patients admitted to a tertiary medical institution in Seoul. To verify the correlations and validity of each convergence with other scales, the Mini-International Neuropsychiatric Interview (MINI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Satisfaction with Life Scale (SWLS) were also conducted to determine convergent and discriminant validity. Then, the receiver operating characteristic (ROC) curve diagnosis values for suicide and depression levels with the highest correlations were analyzed. RESULTS As a result, Cronbach's alpha was 0.826, and when each item was removed sequentially, Cronbach's alpha ranged from 0.736-0.840, showing stable internal consistency. Most of the corrected item-total correlation were over 0.500; however, a relatively low correlation was shown for the fourth and fifth questions, which had values of 0.429 and 0.410, respectively. The test-retest reliability was 0.830, and the MINI and PHQ-9 showed high values of 0.872 and 0.672, respectively. The area under the curve (AUC) according to the ASQ diagnosis value was also the highest for the MINI (0.936). CONCLUSION The validity and reliability of the South Korean version of the ASQ tool were demonstrated. Through this validation, the ASQ tool can be used for simple suicide risk screening (SRS) in hospitalized patients.
Collapse
Affiliation(s)
- Hyun-Jin Kim
- School of Nursing, Hanyang University, Seoul, Korea
| | - Sunhae Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea
| | - Youkyoung Son
- Department of Nursing, Hanyang University Medical Center, Seoul, Korea
| | - Insook Youn
- Department of Nursing, Hanyang University Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea.
| |
Collapse
|
22
|
Hornor G, Tucker S. Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse. JOURNAL OF FORENSIC NURSING 2022; 18:237-246. [PMID: 35704502 DOI: 10.1097/jfn.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.
Collapse
Affiliation(s)
- Gail Hornor
- Author Affiliations: International Association of Forensic Nurses
| | | |
Collapse
|
23
|
Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study. Pediatr Qual Saf 2022; 7:e549. [PMID: 35369419 PMCID: PMC8970087 DOI: 10.1097/pq9.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022] Open
Abstract
Although recommended, adolescent depression screening with appropriate initial management is challenging. This project aimed to improve adolescent depression screening rates during preventive care visits in 12 primary care clinics from 65.4% to 80%, increase the proportion of documented initial management for those with a positive screen from 69.5% to 85%, then sustain improvements for 12 months.
Collapse
|
24
|
Lantos JD, Yeh HW, Raza F, Connelly M, Goggin K, Sullivant SA. Suicide Risk in Adolescents During the COVID-19 Pandemic. Pediatrics 2022; 149:e2021053486. [PMID: 34977942 PMCID: PMC9648059 DOI: 10.1542/peds.2021-053486] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk. METHODS We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess suicide risk among all patients 12 to 24 years of age at a children's hospital. We compared demographics, encounter type (telehealth or face-to-face [F2F]), and screening results from April to June 2020 (T2) to those from April to June 2019 (T1). RESULTS Fewer patients were seen at T2 than T1 (17 986 vs 24 863). A greater proportion of visits at T2 were by telehealth (0% vs 43%). The rate of positive suicide screens was higher in T2 than in T1 (12.2% vs 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15-1.35). The odds of a positive screen were greater for older patients (aOR of 1.12 for age in years; 95% CI, 1.10-1.14), female patients (aOR, 2.23; 95% CI, 2.00-2.48), patients with public versus private insurance (aOR, 1.88; 95% CI, 1.72-2.07), and lower for Black versus White patients (aOR, 0.85; 95% CI, 0.77-0.95). Rates of positive screens were highest among inpatients (20.0%), intermediate for emergency department patients (14.4%), and lowest in outpatient clinics (9.9%) (P < .05). CONCLUSIONS Rates of positive suicide risk screens among adolescents rose in the pandemic's early months with differences related to sociodemographics and visit type. Changes in health care delivery highlight the complexities of assessing and responding to mental health needs of adolescents. Additional research might determine the effects of screening methods and patient populations on screening results.
Collapse
Affiliation(s)
- John D. Lantos
- Children’s Mercy Bioethics Center, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Hung-Wen Yeh
- Divisions of Health Services and Outcomes Research and
| | - Fajar Raza
- Children’s Mercy Bioethics Center, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Mark Connelly
- Developmental and Behavioral Health, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Kathy Goggin
- Divisions of Health Services and Outcomes Research and
- Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Shayla A. Sullivant
- Department of Developmental and Behavioral Sciences, University of Missouri-Kansas City, Kansas City, Missouri
| |
Collapse
|
25
|
Murray PJ, Thoma BC. Effective Screening and Treatment to Reduce Suicide Risk Among Sexual and Gender Minority Youth. Pediatrics 2021; 148:peds.2021-051831. [PMID: 34580172 DOI: 10.1542/peds.2021-051831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pamela J Murray
- Adolescent & Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts .,Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian C Thoma
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
26
|
Mayne SL, Hannan C, Davis M, Young JF, Kelly MK, Powell M, Dalembert G, McPeak KE, Jenssen BP, Fiks AG. COVID-19 and Adolescent Depression and Suicide Risk Screening Outcomes. Pediatrics 2021; 148:peds.2021-051507. [PMID: 34140393 DOI: 10.1542/peds.2021-051507] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health concerns increased during the coronavirus disease 2019 pandemic, but previous studies have not examined depression screening in pediatric primary care. We aimed to describe changes in screening, depressive symptoms, and suicide risk among adolescents during the coronavirus disease 2019 pandemic. METHODS In a repeat cross-sectional analysis of electronic health record data from a large pediatric primary care network, we compared the percentage of primary care visits where adolescents aged 12 to 21 were screened for depression, screened positive for depressive symptoms, or screened positive for suicide risk between June and December 2019 (prepandemic) and June and December 2020 (pandemic). Changes were examined overall, by month, and by sex, race and ethnicity, insurance type, and income. Modified Poisson regression was used to calculate prevalence ratios (PRs) for the prepandemic to pandemic changes. RESULTS Depression screening at primary care visits declined from 77.6% to 75.8% during the pandemic period (PR: 0.98, 95% confidence interval [CI]: 0.90-1.06). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2% (PR: 1.24, 95% CI: 1.15-1.34), with greater increases among female, non-Hispanic Black, and non-Hispanic white adolescents. Positive suicide risk screens increased from 6.1% to 7.1% (PR: 1.16, 95% CI: 1.08-1.26), with a 34% relative increase in reporting recent suicidal thoughts among female adolescents (PR: 1.34, 95% CI: 1.18-1.52). CONCLUSIONS Results suggest that depression and suicide concerns have increased during the pandemic, especially among female adolescents. Results underscore the importance of consistent depression and suicidality screening.
Collapse
Affiliation(s)
- Stephanie L Mayne
- The Possibilities Project, Children's Hospital of Philadelphia .,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Chloe Hannan
- The Possibilities Project, Children's Hospital of Philadelphia.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Molly Davis
- Psychiatry, Perelman School of Medicine.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jami F Young
- Center for Pediatric Clinical Effectiveness and PolicyLab.,Psychiatry, Perelman School of Medicine.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary Kate Kelly
- The Possibilities Project, Children's Hospital of Philadelphia.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Maura Powell
- The Possibilities Project, Children's Hospital of Philadelphia
| | - George Dalembert
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Katie E McPeak
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Brian P Jenssen
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Alexander G Fiks
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| |
Collapse
|
27
|
Rider EA, Ansari E, Varrin PH, Sparrow J. Mental health and wellbeing of children and adolescents during the covid-19 pandemic. BMJ 2021; 374:n1730. [PMID: 34429302 DOI: 10.1136/bmj.n1730] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Elizabeth A Rider
- Department of Pediatrics, Harvard Medical School; and Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Eman Ansari
- Department of Pediatrics, Harvard Medical School; and Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Joshua Sparrow
- Department of Psychiatry, Harvard Medical School; and Brazelton Touchpoints Center, Division of Developmental Medicine, and Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|