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Adjei A, Wilkinson AV, Chen B, Mantey DS, Harrell MB. Does the time to nicotine dependence vary by internalizing symptoms for young people who use e-cigarettes? An analysis of the Population Assessment of Tobacco and Health (PATH) study, (Waves 1-5; 2013-2019). Addict Behav 2024; 156:108075. [PMID: 38810488 DOI: 10.1016/j.addbeh.2024.108075] [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: 12/22/2023] [Revised: 05/03/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people. METHODS Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1-5; 2013-2019). The study included 2,102 (N = 5,031,691) young people (age 12-23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms. RESULTS We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92-1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92-1.89) and use within 30 min of waking for follow-up times 0-156 weeks (AHR = 0.84; 95 % CI = 0.55-1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04-4.67) respectively. CONCLUSION Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.
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Affiliation(s)
- Abigail Adjei
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Anna V Wilkinson
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Dale S Mantey
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
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2
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Rhee TG, Bommersbach TJ, Rosenheck RA, Nierenberg AA, McIntyre RS. National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States. J Affect Disord 2024; 358:342-349. [PMID: 38734245 DOI: 10.1016/j.jad.2024.05.044] [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: 10/03/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). METHODS Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. RESULTS Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. CONCLUSION Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | | | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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3
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Lee CM, Kaplan RM, Nelson SC, Horvitz-Lennon M. Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health. Child Adolesc Psychiatr Clin N Am 2024; 33:457-470. [PMID: 38823817 DOI: 10.1016/j.chc.2024.03.008] [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: 06/03/2024]
Abstract
An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, UCSF, 675 18th Street, Box 3132, San Francisco, CA 94143, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzie C Nelson
- Department of Psychiatry, Wright State University, 2555 University Boulevard, Dayton, OH 45324, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA 02116, USA; Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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4
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Childs KK, Elligson RL, Brady CM. Testing the Impact of a Law Enforcement-Operated Co-responder Program for Youths: A Quasi-Experimental Approach. Psychiatr Serv 2024:appips20240003. [PMID: 38938094 DOI: 10.1176/appi.ps.20240003] [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: 06/29/2024]
Abstract
OBJECTIVE The authors examined whether use of a co-responder program reduced the likelihood of an involuntary commitment examination as the disposition of a police encounter with youths experiencing a mental health crisis and 1 year after the initial incident. METHODS Using a quasi-experimental design, the authors compared 206 incidents that involved the co-response program with 327 incidents that did not involve the program. Propensity score matching was used to balance groups on demographic and incident characteristics. The dependent variables included the disposition of the incident (deescalation or involuntary commitment examination), whether the youths experienced a later involuntary commitment examination within 1 year of the initial intervention, and time to the subsequent examination. Propensity score-weighted binary logistic regression and time-to-event analysis were used. RESULTS The co-responder program was associated with a significantly lower likelihood of police officer-initiated involuntary commitment examinations and a lower likelihood of an involuntary commitment examination within 1 year. Eighty percent of the incidents that resulted in a co-response involving a police officer and a mental health professional were deescalated, allowing the youth to remain in the community with a safety plan, whereas 17% of incidents with a police-only response ended with crisis deescalation. CONCLUSIONS These findings provide further support for the implementation of co-responder options that are available to police officers during encounters with children and adolescents experiencing a mental health crisis.
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Affiliation(s)
- Kristina K Childs
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
| | - Richard L Elligson
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
| | - Caitlin M Brady
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
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5
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Archuleta S, Allison-Burbank JD, Ingalls A, Begay R, Begaye V, Howe L, Tsosie A, Keryte AP, Haroz EE. Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation During COVID-19. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38936839 DOI: 10.1111/josh.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID-19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed-methods approach, integrating community-based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation-based schools. We conducted an analysis of caregiver self-report baseline data collected between August 2021 and May 2022. RESULTS A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non-Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in-person, hybrid, and online-only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self-efficacy. CONCLUSIONS This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts.
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Affiliation(s)
- Shannon Archuleta
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joshuaa D Allison-Burbank
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison Ingalls
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Renae Begay
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Vanessa Begaye
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lacey Howe
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alicia Tsosie
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Angelina Phoebe Keryte
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Emily E Haroz
- Department of International Health, Center for Indigenous Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Mahmood A, Kedia S, Arshad H, Mou X, Dillon PJ. Disparities in Access to Mental Health Services Among Children Diagnosed with Anxiety and Depression in the United States. Community Ment Health J 2024:10.1007/s10597-024-01305-3. [PMID: 38907843 DOI: 10.1007/s10597-024-01305-3] [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: 11/02/2023] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Child and adolescent mental health are major public health concerns in the US. Overall, 20% of US children have a reported mental health condition, while an estimated 40% will be diagnosed with one by age 18. Despite these concerns, little is known about factors associated with access to mental health services among children and adolescents. We analyzed data from a sample of 6655 children (aged 6 to 17 years) with either anxiety and/or depression drawn from the 2020-2021 National Survey of Children's Health (NSCH). A multivariable logistic regression model was fit to investigate predisposing, enabling, and need factors associated with caregiver's (i.e., parent or other guardian) perceived access to mental health services for their children. Approximately 50.8% of caregivers perceived obtaining mental health services for their children to be somewhat difficult, very difficult, or impossible. Children meeting criteria for having a medical home had lower odds of experiencing such difficulties (adjusted [a]OR = 0.38; 95% CI: 0.30-0.49). Further, compared to children who sometimes or never had health insurance coverage for mental or behavioral health needs, children who were always insured (aOR: 0.19; 95% CI 0.14, 0.25) and those who usually had coverage (aOR: 0.38; 95% CI 0.28, 0.51) had lower odds of experiencing perceived difficulties in obtaining care. The results indicate several enabling and need predictors of perceived access to mental health services--highlighting potential structural barriers to care access. Efforts to address access challenges should adopt a multifaceted approach and be tailored to families living in poverty, those with limited health coverage, and minoritized children with less than optimal general health.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Xichen Mou
- Division of Epidemiology, Biostatistics, Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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7
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Soleimanpour S, Simmons C, Saphir M, Ng S, Jenks K, Geierstanger S. Equity in Mental Health Care Receipt among Youth Who Use School-Based Health Centers. Am J Prev Med 2024:S0749-3797(24)00195-8. [PMID: 38876296 DOI: 10.1016/j.amepre.2024.06.004] [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] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients. METHODS Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021-2023 were analyzed in 2023-2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings. RESULTS Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63). CONCLUSIONS SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care.
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Affiliation(s)
- Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies & Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Cailey Simmons
- Public Health and Preventive Medicine Residency Program, California Department of Public Health, Berkeley, CA
| | - Melissa Saphir
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Sandy Ng
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Kale Jenks
- Center for Healthy Schools and Communities, Alameda County Health Care Services Agency, San Leandro, CA
| | - Sara Geierstanger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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Gertler TS, Blackford R. Bringing nutritional ketosis to the table as an option for healing the pediatric brain. Front Nutr 2024; 11:1408327. [PMID: 38933892 PMCID: PMC11199727 DOI: 10.3389/fnut.2024.1408327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Our core premise is that personalized variations of a ketogenic diet are likely to benefit pediatric patients with neuropsychiatric symptoms across multiple domains. Although pediatric epilepsy is currently a well-accepted indication for a strict ketogenic diet, there is a dearth of knowledge and therefore clinical guidelines upon which to recommend nutritional ketosis for pervasive pediatric conditions such as autism spectrum disorder and ADHD, even when comorbid epilepsy is present. However, there are published cohort studies and current clinical trials implementing medical ketogenic therapies for cognitive impairment, psychiatric comorbidities, motor disability, and even neuroinflammation. As holistic practitioners, it is imperative that we consider the health of a child in its entirety - and additionally offer the ketogenic diet as a therapeutic option when it may be synergistic in treating extra-neurologic diseases such as obesity. While there are uniquely pediatric potential adverse side effects such as linear growth deceleration and micronutrient deficiencies, previous trials in epilepsy and our center's experience have already proven the ketogenic diet to be a low-risk intervention when optimized with appropriate patient monitoring and support.
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Affiliation(s)
- Tracy S. Gertler
- Division of Pediatric Neurology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Robyn Blackford
- Division of Clinical Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
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Bommersbach TJ, Olfson M, Rhee TG. National Trends in Emergency Department Visits for Suicide Attempts and Intentional Self-Harm. Am J Psychiatry 2024:appiajp20230397. [PMID: 38831705 DOI: 10.1176/appi.ajp.20230397] [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: 06/05/2024]
Abstract
OBJECTIVE This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020. METHODS Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated. RESULTS The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional. CONCLUSIONS A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
| | - Mark Olfson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
| | - Taeho Greg Rhee
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
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Graves JM, Abshire DA, Koontz E, Mackelprang JL. Identifying Challenges and Solutions for Improving Access to Mental Health Services for Rural Youth: Insights from Adult Community Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:725. [PMID: 38928971 DOI: 10.3390/ijerph21060725] [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: 05/03/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
In the rural United States, provider shortages, inadequate insurance coverage, high poverty rates, limited transportation, privacy concerns, and stigma make accessing mental healthcare difficult. Innovative, localized strategies are needed to overcome these barriers, but little is known about what strategies may be feasible in, or acceptable to, rural communities. We aimed to identify barriers youth face in accessing mental healthcare in rural Washington State and to generate ideas to improve access. METHODS Semi-structured, key informant interviews were conducted by telephone with adult community members, including parents, teachers, and healthcare providers. Participants answered questions related to barriers to mental healthcare access that confront youth and approaches to improving access. Detailed, de-identified field notes were analyzed using conventional content analysis. RESULTS Limited resources and stigma were the two primary barriers to accessing mental healthcare that youth encounter in the community. Limited resources included lack of services and transportation, inconsistent funding and mental health programming, and workforce shortages. Stigma associated with seeking mental healthcare was of particular concern for youth with diverse identities who experience additional stigma. CONCLUSIONS Improving access to mental healthcare for rural youth will require building a strong mental health workforce and championing efforts to reduce stigma associated with help-seeking.
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Affiliation(s)
- Janessa M Graves
- WWAMI Rural Health Research Center, Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
- College of Nursing, Washington State University, Spokane, WA 99201, USA
| | | | - Elissa Koontz
- College of Nursing, Washington State University, Spokane, WA 99201, USA
| | - Jessica L Mackelprang
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne 3122, Australia
- Global and Engagement, Federation University, Melbourne 3000, Australia
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Terry MS, Brown C, Franklin L. Addressing Geographical Inequities and Barriers in Access to Mental Health Care among Youth in a Rural Western Kentucky County. Community Ment Health J 2024:10.1007/s10597-024-01294-3. [PMID: 38829469 DOI: 10.1007/s10597-024-01294-3] [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: 02/10/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
A Community Health Assessment (CHA) was conducted among community members in a rural Western Kentucky county in 2022-2023 identified mental health as one of the top health issues in the county. The purpose of a CHA is to identify key health needs and issues through data and develop strategies for action. One of the objectives was to identify barriers to accessing mental health care, especially among youth. Secondary data analyses were performed from survey results conducted by the local health department and local public schools. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using a two-cycle coding process. Access to mental healthcare is an area of great need in this rural Western Kentucky county. Recommendations include working with healthcare providers, especially specialists, to accept Medicaid and it is recommended to cross-train other professionals to address mental health needs in this region.
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Affiliation(s)
- Miranda Sue Terry
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA.
| | - Charles Brown
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA
| | - Lauren Franklin
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA
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Richardson KA, Punke ELA, Dabrowski BS, Teply AL, Walker J, McKibbin CL. Parent Intention to Participate in an Online Intervention to Enhance Health Behavior Change Among Youth Treated with Psychotropic Medication Who are Overweight or Obese: An Application of the Theory of Planned Behavior. JOURNAL OF PREVENTION (2022) 2024; 45:431-450. [PMID: 38446270 DOI: 10.1007/s10935-024-00773-3] [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] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
Youth with mental health disorders (MHD), particularly those who take psychotropic medications, are at increased risk of being overweight or obese (OW/OB) when compared to typical youth. Parents are important resources for interventions addressing OW/OB. However, parents of youth with MHD may face challenges that require interventions designed to address their needs. Prior to investing research funding in the development of interventions for this group, research is needed to understand factors associated with parents' decisions to enroll in these programs. The theory of planned behavior (TPB) provided a framework for examining parents' salient beliefs, direct attitudes, and intention to enroll in a hypothetical online healthy lifestyle intervention for their youth (ages 11-17) with OW/OB and treated with psychotropic medication. Parents who were enrolled in the study (n = 84) completed demographic questionnaires and a TPB questionnaire which was constructed for this study. A confirmatory factor analysis (CFA) of the direct attitude (i.e., attitude toward the behavior, subjective norm, perceived behavioral control) questions generally supported the three-factor model (i.e., RMSEA = .07, 90% CI .03-.11, p = .18; CFI = .96, SRMR = .06). Results from a multiple regression analysis demonstrated that direct attitudes predicted parent intention to participate in an online healthy lifestyle intervention for this sample of youth accounting for 84% of variance. In this preliminary study, the TPB appears to be a promising framework for understanding direct attitudes associated with parent intentions toward intervention participation in this population of youth. Interventions for parents of youth with OW/OB who are prescribed psychotropic medication should consider addressing these direct attitudes to improve intention.
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Affiliation(s)
| | | | | | - Abby L Teply
- Department of Psychology, University of Wyoming, Laramie, WY, 82072, USA
| | - Johnathan Walker
- Department of Psychology, University of Wyoming, Laramie, WY, 82072, USA
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Hidinger I, Kong L, Ely A. Associations of strabismus surgery timing in childhood with mental health: a retrospective cohort study. J AAPOS 2024; 28:103929. [PMID: 38705352 PMCID: PMC11156528 DOI: 10.1016/j.jaapos.2024.103929] [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: 12/17/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To investigate the incidence of psychiatric diagnoses in relation to strabismus surgery timing among children with an early strabismus diagnosis who underwent surgery in childhood. METHODS We conducted a retrospective cohort study using TriNetX network data from 2003-2023 on patients diagnosed with strabismus at ≤5 years of age and having strabismus surgery before 18 years of age. Cohort 1 comprised patients who underwent initial strabismus surgery at ≤6 years of age; cohort 2, patients with initial surgical intervention at ≥7 years of age. Incidence of mental health diagnoses from 7 until 18 years of age were compared between cohorts. RESULTS In cohort 1, 59 of 688 patients (8.6%) of patients were diagnosed with at least 1 mental health disorder versus 123 of 693 patients (17.7%) in cohort 2 (risk ratio [RR] = 2.07; 95% CI, 1.546 to 2.77; P < 0.0001). Gender analysis showed that only males had a statistically significant increased rate of mental health diagnoses in cohort 2 versus cohort 1 (RR = 1.82; 95% CI, 1.284 to 2.577; P = 0.006). An increased risk for specific psychiatric diagnoses was found in cohort 2 versus cohort 1; anxiety disorders (RR = 2.19; 95% CI, 1.225-3.922; P = 0.0065), attention-deficit / hyperactivity disorder (RR = 2.18; 95% CI, 1.499-3.175; P < 0.0001), conduct disorders (RR = 2.81; 95% CI, 1.425-5.556; P = 0.0018), and adjustment disorders (RR = 2.07; 955% CI, 1.103-3.876; P = 0.0204). Depressive disorders showed no statistically significant difference between cohorts (RR = 1.00; 95% CI, 0.419-2.392; P = 0.9974). CONCLUSIONS Compared with children having early strabismus surgery, those having surgery at a later age after an early strabismus diagnosis at ≤5 years of age may be more likely to experience a mental health disorder during childhood, although it is unclear whether such disorders are a result of delayed surgery or a driver of the decision to opt for surgery rather than continued conservative management.
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Affiliation(s)
- Ian Hidinger
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Lan Kong
- Department of Public Health Science, Penn State College of Medicine, Hershey, Pennsylvania
| | - Amanda Ely
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania.
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Dy-Hollins ME, Carr SJ, Essa A, Osiecki L, Lackland DT, Voeks JH, Mejia NI, Sharma N, Budman CL, Cath DC, Grados MA, King RA, Lyon GJ, Rouleau GA, Sandor P, Singer HS, Chibnik LB, Mathews CA, Scharf JM. The Challenge of Examining Social Determinants of Health in People Living With Tourette Syndrome. Pediatr Neurol 2024; 155:55-61. [PMID: 38608551 PMCID: PMC11132913 DOI: 10.1016/j.pediatrneurol.2024.02.008] [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: 10/12/2023] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To examine the association between race, ethnicity, and parental educational attainment on tic-related outcomes among Tourette Syndrome (TS) participants in the Tourette Association of America International Consortium for Genetics (TAAICG) database. METHODS 723 participants in the TAAICG dataset aged ≤21 years were included. The relationships between tic-related outcomes and race and ethnicity were examined using linear and logistic regressions. Parametric and nonparametric tests were performed to examine the association between parental educational attainment and tic-related outcomes. RESULTS Race and ethnicity were collapsed as non-Hispanic white (N=566, 88.0%) versus Other (N=77, 12.0%). Tic symptom onset was earlier by 1.1 years (P < 0.0001) and TS diagnosis age was earlier by 0.9 years (P = 0.0045) in the Other group (versus non-Hispanic white). Sex and parental education as covariates did not contribute to the differences observed in TS diagnosis age. There were no significant group differences observed across the tic-related outcomes in parental education variable. CONCLUSIONS Our study was limited by the low number of nonwhite or Hispanic individuals in the cohort. Racial and ethnic minoritized groups experienced an earlier age of TS diagnosis than non-Hispanic white individuals. Tic severity did not differ between the two groups, and parental educational attainment did not affect tic-related outcomes. There remain significant disparities and gaps in knowledge regarding TS and associated comorbid conditions. Our study suggests the need for more proactive steps to engage individuals with tic disorders from all racial and ethnic minoritized groups to participate in research studies.
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Affiliation(s)
- Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Samuel J Carr
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angela Essa
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Osiecki
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel T Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Jenifer H Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, and Drenthe Mental Health Institute, Groningen, Netherlands
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A King
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Gholson J Lyon
- George A. Jervis Clinic and Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Paul Sandor
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harvey S Singer
- Departments of Pediatrics and Neurology, Johns Hopkins Hospital, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lori B Chibnik
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, University of Florida, Gainsville, Florida
| | - Jeremiah M Scharf
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Barreca JA. Exploring the Relationship between Adverse Childhood Experiences (ACEs) and Mental Health in Low Birthweight Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:585-596. [PMID: 38938970 PMCID: PMC11199437 DOI: 10.1007/s40653-023-00577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 06/29/2024]
Abstract
Low birthweight is associated with poor health, developmental, and social outcomes throughout the lifespan. Exposure to adverse childhood experiences (ACEs) is also associated with negative mental and physical health outcomes in adulthood. The aims of this study were to explore the relationship between low birthweight (LBW), exposure to ACES, and subsequent utilization of mental health service. Data analysis was conducted using a subset of data from children ages 6-17 years from the National Survey of Children's Health (NSCH) for 2018-2019 (n = 40,656). Welch ANOVA, Pearson's chi-square, and logistic regression investigated the relationship between LBW, ACEs, and mental health. LBW children in this sample had higher exposure to ACEs when compared to not low birthweight (NBW) children. LBW children also had a higher reported incidence of identified mental health (MH) issues. There was no significant association between birthweight and unmet MH service needs. LBW children with an ACE score or two or more were more likely to have an unidentified MH issue and/or an unmet MH service need. The results demonstrate LBW children experience higher levels of adversity. Children with ACE scores of two or more and those with unidentified MH issues have a higher likelihood of unmet MH needs. Professionals working in the health, education, and social service sectors can use this information to raise awareness of the increased vulnerability and more effectively meet the mental health needs of LBW children.
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Affiliation(s)
- Jessica A. Barreca
- Center for Interprofessional Education and Research, Saint Louis University, 1312 Carr Lane, Suite 110, St. Louis, MO 63104 USA
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16
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Askari MS, Belsky DW, Olfson M, Breslau J, Mojtabai R, Kajeepeta S, Bruzelius E, Keyes KM. An integrative literature review of birth cohort and time period trends in adolescent depression in the United States. Soc Psychiatry Psychiatr Epidemiol 2024; 59:899-915. [PMID: 37428192 DOI: 10.1007/s00127-023-02527-8] [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: 11/21/2022] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022. METHODS We conducted an integrative systematic literature review. Three reviewers participated at different stages of article review. Of the 2234 articles identified in three databases (Pubmed, ProQuest Central, Ebscohost), 10 met inclusion criteria (i.e., adolescent aged United States populations, included information about birth cohort and survey year, focused on depressive symptoms/disorders). RESULTS All 10 articles observed increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, declining mental health stigma, increased treatment, and, in more recent years, the COVID-19 pandemic. CONCLUSIONS Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991 to 2020. Mechanisms driving this increase are still unknown. Research to identify these mechanisms is needed to inform depression screening and intervention efforts for adolescents.
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Affiliation(s)
- Melanie S Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Mark Olfson
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 797, Baltimore, MD, 21205, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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17
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Ostdiek-Wille GP, Bavitz KC, Kohn TP, Deibert CM. Attention-deficit hyperactivity disorder medication use is associated with testosterone hypofunction-results from a national claims database analysis. Int J Impot Res 2024; 36:403-407. [PMID: 38129694 DOI: 10.1038/s41443-023-00805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
Male hypogonadism is not a risk associated with attention-deficit hyperactivity disorder (ADHD) stimulant medications, but recent studies have explored this connection. Though the pathophysiologic connection remains unclear, we predicted that long-term use of ADHD stimulant medications could increase the risk of hypogonadism in post-pubertal males. Utilizing TriNetX, LLC Research Network data from January 2000 through December 2019, men older than 18 with ADHD receiving long-term stimulant medication (>36 monthly prescriptions) were selected for the study population. Two control groups were constructed: individuals with ADHD but no stimulant medication use, and individuals without ADHD or stimulant medication use. A diagnosis of testicular hypofunction (ICD-10: E29.1) within five years of long-term ADHD stimulant medication use was the chosen primary outcome. After propensity score matching, 17,224 men were analyzed in each group. Of the men with long-term ADHD stimulant medication use, 1.20% were subsequently diagnosed with testicular hypofunction compared to 0.67% of individuals with ADHD without stimulant medication use (RR: 1.78, 95% CI: 1.42-2.23) and 0.68% in men without ADHD or stimulant medication use (RR: 1.75, 95% CI: 1.39-2.19). Therefore, chronic ADHD stimulant medication use was found to be significantly associated with a subsequent diagnosis of testicular hypofunction.
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Affiliation(s)
| | - Kyle C Bavitz
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Sleath B, Beznos B, Carpenter D, Thomas K, Annis I, Tudor G, Garcia N, Adjei A, Anastopoulos A, Leslie L, Coyne I. A pre-visit video/question prompt list intervention to increase youth question-asking about attention deficit hyperactivity disorder during pediatric visits. PATIENT EDUCATION AND COUNSELING 2024; 127:108320. [PMID: 38851012 DOI: 10.1016/j.pec.2024.108320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To conduct a pragmatic randomized controlled trial to test the effectiveness of an ADHD question prompt list with video intervention to increase youth question-asking and provider education about ADHD during visits. METHODS English-speaking youth ages 11-17 with ADHD and their caregivers were enrolled from two pediatric clinics. Youth were randomized to intervention or usual care groups. Intervention group adolescents watched the video and then completed an ADHD question prompt list before their visits. Multivariable regression was used to analyze the data. RESULTS Twenty-one providers and 102 of their patients participated. Intervention group youth were significantly more likely to ask one or more questions about ADHD and its treatment than usual care youth (odds ratio=5.4, 95 % Confidence Interval (CI)= 1.8, 15.9). Providers were significantly more likely to educate youth who asked one or more questions during visits about more ADHD medication areas (unstandardized beta=0.98, 95 % CI=0.31 to 1.64) and more non-medication strategies for ADHD (unstandardized beta=0.50, 95 % CI=0.13 to 0.88). CONCLUSION The intervention increased youth question-asking about ADHD and its treatment. Providers provided more education to youth who asked one or more questions about ADHD and its treatment. PRACTICE IMPLICATIONS Providers and practices should consider having youth complete ADHD question prompt lists and watch the video before visits to increase youth question-asking during visits.
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Affiliation(s)
- Betsy Sleath
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Bethany Beznos
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Delesha Carpenter
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Kathleen Thomas
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Izabela Annis
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA.
| | - Nacire Garcia
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Abena Adjei
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | | | - Laurel Leslie
- American Board of Pediatrics, Chapel Hill, NC, USA; Tufts University School of Medicine, Boston, MA, USA.
| | - Imelda Coyne
- Trinity College Dublin, College Green, Dublin 2, Ireland.
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19
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Wolf ER, Rivara FP, Orr CJ, Sen A, Chapman DA, Woolf SH. Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth. JAMA 2024; 331:1732-1740. [PMID: 38703403 PMCID: PMC11070063 DOI: 10.1001/jama.2024.3908] [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: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024]
Abstract
Importance Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.
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Affiliation(s)
- Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
- Editor, JAMA Network Open
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Anabeel Sen
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Derek A. Chapman
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Steven H. Woolf
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond
- Center on Society and Heath, Virginia Commonwealth University School of Population Health, Richmond
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20
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Honda H. The necessity for a simple and reliable screening tool for developmental concerns: Validity of the ESSENCE-Q. Dev Med Child Neurol 2024. [PMID: 38801108 DOI: 10.1111/dmcn.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Hideo Honda
- Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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21
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Shi JM, Chiu VY, Avila CC, Lewis S, Park D, Peltier MR, Getahun D. Coding of Childhood Psychiatric and Neurodevelopmental Disorders in Electronic Health Records of a Large Integrated Health Care System: Validation Study. JMIR Ment Health 2024; 11:e56812. [PMID: 38771217 PMCID: PMC11107768 DOI: 10.2196/56812] [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: 01/31/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024] Open
Abstract
Background Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature. objectives We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system's electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic. Methods Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. κ statistic for interrater reliability among the 2 abstractors was calculated. Results The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (κ=95%). Conclusions Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system.
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Affiliation(s)
- Jiaxiao M Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Vicki Y Chiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Chantal C Avila
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Sierra Lewis
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daniella Park
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Morgan R Peltier
- Department of Psychiatry, Jersey Shore University Medical Center, Neptune, NJ, United States
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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22
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Ghose SS, Patel NA, Marshall T, George P, Taylor J, Karakus M, Crocker L, Hoey T, Goldman HH. Assessing the Evidence Base for School-Based Promotion and Prevention Interventions: Introduction to the Series. Psychiatr Serv 2024:appips20230542. [PMID: 38736359 DOI: 10.1176/appi.ps.20230542] [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: 05/14/2024]
Abstract
Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) Series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB Series used the rating criteria derived from the 2014 AEB Series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.
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Affiliation(s)
- Sushmita Shoma Ghose
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Nikhil A Patel
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Tina Marshall
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Preethy George
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Jeffrey Taylor
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Mustafa Karakus
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Laura Crocker
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Tabitha Hoey
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Howard H Goldman
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
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23
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Black LI, Ghandour RM, Brosco JP, Payne SI, Houtrow A, Kogan MD, Bethell CD. An Expanded Approach to the Ascertainment of Children and Youth With Special Health Care Needs. Pediatrics 2024; 153:e2023065131. [PMID: 38712452 DOI: 10.1542/peds.2023-065131] [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] [Accepted: 03/08/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE To describe the prevalence, characteristics, and health-related outcomes of children with diagnosed health conditions and functional difficulties who do not meet criteria for having a special health care need based on the traditional scoring of the Children with Special Health Care Needs (CSHCN) Screener. METHODS Data come from the 2016 to 2021 National Survey of Children's Health (n = 225 443). Child characteristics and health-related outcomes were compared among 4 mutually exclusive groups defined by CSHCN Screener criteria and the presence of both conditions and difficulties. RESULTS Among children who do not qualify as children and youth with special health care needs (CYSHCN) on the CSHCN Screener, 6.8% had ≥1 condition and ≥1 difficulty. These children were more likely than CYSHCN to be younger, female, Hispanic, uninsured, privately insured, living in a household with low educational attainment, have families with more children and a primary household language other than English. After adjustment, non-CYSHCN with ≥1 conditions and ≥1 difficulty were less likely than CYSHCN, but significantly more likely than other non-CYSHCN, to have ≥2 emergency department visits, have unmet health care needs, not meet flourishing criteria, live in families that experienced child health-related employment impacts and frustration accessing services. Including these children in the calculation of CYSHCN prevalence increases the national estimate from 19.1% to 24.6%. CONCLUSIONS Approximately 4 million children have both a diagnosed health condition and functional difficulties but are not identified as CYSHCN. An expanded approach to identify CYSHCN may better align program and policy with population needs.
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Affiliation(s)
- Lindsey I Black
- Health Resources and Services Administration, Maternal and Child Health Bureau on Detail From the Centers for Disease Control and Prevention, National Center for Health Statistics, Rockville, Maryland
| | - Reem M Ghandour
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Jeffrey P Brosco
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Shirley I Payne
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Amy Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael D Kogan
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
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24
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Wiener RC, Waters C, Bhandari R. Association of general anxiety and pediatric dental preventive examination utilization, National Survey of Children's Health, 2021. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38711189 DOI: 10.1111/scd.13015] [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: 01/18/2024] [Revised: 03/25/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN). METHODS National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations. RESULTS The sample included 10 493 CSHCN, and 35 675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively). CONCLUSION Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children. PRACTICAL IMPLICATIONS CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Christopher Waters
- Department of Dental Research, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
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25
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Maher BS, Bitsko RH, Claussen AH, O'Masta B, Cerles A, Holbrook JR, Mahmooth Z, Chen-Bowers N, Rojo ALA, Kaminski JW, Rush M. Systematic Review and Meta-analysis of the Relationship Between Exposure to Parental Substance Use and Attention-Deficit/Hyperactivity Disorder in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:291-315. [PMID: 37976008 PMCID: PMC11098969 DOI: 10.1007/s11121-023-01605-2] [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] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.
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Affiliation(s)
- Brion S Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Naomi Chen-Bowers
- Office Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H 21-11, Atlanta, GA, 30329, USA
| | | | - Jennifer W Kaminski
- Office Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H 21-11, Atlanta, GA, 30329, USA.
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26
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Danielson ML, Claussen AH, Bitsko RH, Katz SM, Newsome K, Blumberg SJ, Kogan MD, Ghandour R. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:343-360. [PMID: 38778436 DOI: 10.1080/15374416.2024.2335625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide updated national prevalence estimates of diagnosed attention-deficit/hyperactivity disorder (ADHD), ADHD severity, co-occurring disorders, and receipt of ADHD medication and behavioral treatment among U.S. children and adolescents by demographic and clinical subgroups using data from the 2022 National Survey of Children's Health (NSCH). METHOD This study used 2022 NSCH data to estimate the prevalence of ever diagnosed and current ADHD among U.S. children aged 3-17 years. Among children with current ADHD, ADHD severity, presence of current co-occurring disorders, and receipt of medication and behavioral treatment were estimated. Weighted estimates were calculated overall and for demographic and clinical subgroups (n = 45,169). RESULTS Approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children) and 10.5% (6.5 million) had current ADHD. Among children with current ADHD, 58.1% had moderate or severe ADHD, 77.9% had at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year; nearly one third (30.1%) did not receive any ADHD-specific treatment. CONCLUSIONS Pediatric ADHD remains an ongoing and expanding public health concern, as approximately 1 million more children had ever received an ADHD diagnosis in 2022 than in 2016. Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for needs of children with ADHD.
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Affiliation(s)
- Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Angelika H Claussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Samuel M Katz
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
- Oak Ridge Institute for Science and Education
| | - Kimberly Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention
| | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration
| | - Reem Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration
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27
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Choi K, Ayala L, Lierly R, Bustamante D, Cioppa-Fong B, Mead M, Mkroyan HJ, Morris E, Babajanyan I, Maryanov D. Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry. J Am Psychiatr Nurses Assoc 2024; 30:722-732. [PMID: 37853611 PMCID: PMC11141099 DOI: 10.1177/10783903231171590] [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: 10/20/2023]
Abstract
INTRODUCTION Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. AIMS The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. METHODS This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. RESULTS There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. CONCLUSION Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.
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Affiliation(s)
- Kristen Choi
- Kristen Choi, PhD, RN, FAAN, University of California, Los Angeles, Los Angeles, CA, USA; Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Leilanie Ayala
- Leilanie Ayala, PMHNP-BC, Sutter Center for Psychiatry, Sacramento, CA, USA; University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca Lierly
- Rebecca Lierly, PhD, Sutter Center for Psychiatry, Sacramento, CA, USA
| | - Daniela Bustamante
- Daniela Bustamante, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Benjamin Cioppa-Fong
- Benjamin Cioppa-Fong, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Meredith Mead
- Meredith Mead, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Hagop J. Mkroyan
- Hagop J. Mkroyan, MSN, PMHNP-BC, Nutrix Care Partners, Los Angeles, CA, USA
| | - Elizabeth Morris
- Elizabeth Morris, PsyD, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Irina Babajanyan
- Irina Babajanyan, AMFT, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Daniel Maryanov
- Daniel Maryanov, MSN, RN, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
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28
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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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Withdrawal: Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19. THE JOURNAL OF SCHOOL HEALTH 2024; 94:481. [PMID: 38225814 PMCID: PMC10987271 DOI: 10.1111/josh.13419] [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: 05/24/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024]
Abstract
Withdrawal: 'Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19' by Shannon Archuleta MPH, Joshuaa D. Allison-Burbank PhD, Allison Ingalls MPH, Renae Begay MPH, Ryan Grass BS, Francene Larzelere PhD, Vanessa Begaye BS, Lacey Howe BS, Alicia Tsosie BS, Angelina Phoebe Keryte BA, Emily E. Haroz PhD, J Sch Health 2024, 10.1111/josh.13419. The above article, published online on 15 January 2024 in Wiley Online Library (https://onlinelibrary.wiley.com/doi/full/10.1111/josh.13419) has been withdrawn by agreement between the authors, the journal's Editor in Chief, Michael W. Long, the American School Health Association and Wiley Periodicals LLC. The withdrawal has been agreed because consent for publication from one of the tribes participating in the study was pending at the time of publication.
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30
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Dimitrov LV, Kaminski JW, Holbrook JR, Bitsko RH, Yeh M, Courtney JG, O'Masta B, Maher B, Cerles A, McGowan K, Rush M. A Systematic Review and Meta-analysis of Chemical Exposures and Attention-Deficit/Hyperactivity Disorder in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:225-248. [PMID: 38108946 PMCID: PMC11132938 DOI: 10.1007/s11121-023-01601-6] [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] [Accepted: 10/17/2023] [Indexed: 12/19/2023]
Abstract
Exposure to certain chemicals prenatally and in childhood can impact development and may increase risk for attention-deficit/hyperactivity disorder (ADHD). Leveraging a larger set of literature searches conducted to synthesize results from longitudinal studies of potentially modifiable risk factors for childhood ADHD, we present meta-analytic results from 66 studies that examined the associations between early chemical exposures and later ADHD diagnosis or symptoms. Studies were eligible for inclusion if the chemical exposure occurred at least 6 months prior to measurement of ADHD diagnosis or symptomatology. Included papers were published between 1975 and 2019 on exposure to anesthetics (n = 5), cadmium (n = 3), hexachlorobenzene (n = 4), lead (n = 22), mercury (n = 12), organophosphates (n = 7), and polychlorinated biphenyls (n = 13). Analyses are presented for each chemical exposure by type of ADHD outcome reported (categorical vs. continuous), type of ADHD measurement (overall measures of ADHD, ADHD symptoms only, ADHD diagnosis only, inattention only, hyperactivity/impulsivity only), and timing of exposure (prenatal vs. childhood vs. cumulative), whenever at least 3 relevant effect sizes were available. Childhood lead exposure was positively associated with ADHD diagnosis and symptoms in all analyses except for the prenatal analyses (odds ratios (ORs) ranging from 1.60 to 2.62, correlation coefficients (CCs) ranging from 0.14 to 0.16). Other statistically significant associations were limited to organophosphates (CC = 0.11, 95% confidence interval (CI): 0.03-0.19 for continuous measures of ADHD outcomes overall), polychlorinated biphenyls (CC = 0.08, 95% CI: 0.02-0.14 for continuous measures of inattention as the outcome), and both prenatal and childhood mercury exposure (CC = 0.02, 95% CI: 0.00-0.04 for continuous measures of ADHD outcomes overall for either exposure window). Our findings provide further support for negative impacts of prenatal and/or childhood exposure to certain chemicals and raise the possibility that primary prevention and targeted screening could prevent or mitigate ADHD symptomatology. Furthermore, these findings support the need for regular review of regulations as our scientific understanding of the risks posed by these chemicals evolves.
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Affiliation(s)
- Lina V Dimitrov
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Yeh
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph G Courtney
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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31
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Ilori EO, Eziechi NM, Erechukwu C, Obijiofor NB, Agazie O, Obitulata-Ugwu VO, Okobi OE, Aderemi L, Salawu MA, Ewuzie ZD, Anamazobi EG, Alozie AS. Analyzing Trends in Mental and Behavioral Health Support for Children: A Comprehensive Study Using National Survey of Children's Health Database. Cureus 2024; 16:e59499. [PMID: 38826937 PMCID: PMC11143464 DOI: 10.7759/cureus.59499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
Objective This study aimed to explore mental and behavioral health support trends for children aged 3-17, analyzing treatment and counseling using United States data from the 2016-2020 National Survey of Children's Health (NSCH) database. Methods Employing a retrospective observational design, we systematically retrieved and analyzed NSCH Database data from 2016 to 2020. The focus was on understanding mental and behavioral health treatment percentages over time, specifically targeting demographic variations such as age groups, gender, race/ethnicity, and the federal poverty level percentage. Graphical representation utilized Excel, summarizing results based on aggregated data for distinct time intervals, highlighting the importance of mental and behavioral health support for children aged 3-17. Results The study identified significant temporal trends in mental and behavioral health treatment, revealing notable fluctuations across demographic and socio-economic variables. Of the 22,812 participants, 51.7% (CI: 50.2-53.1%, n=12,686) received treatment, exposing disparities. Gender differences were evident, with higher treatment rates in females (53.7%, CI: 51.6-55.9%, n=6,166) than males (50.1%, CI: 48.2-52.0%, n=6,520). Age-specific patterns indicated lower intervention rates in younger children (33.5%, CI: 28.6-38.8%, n=447, ages 3-5) compared to adolescents (58.1%, CI: 56.2-59.9%, n=8, 222 ages 12-17). Conclusion The conclusion highlights significant temporal fluctuations and pronounced demographic disparities. Findings underscore varying prevalence rates among age groups, genders, racial/ethnic backgrounds, and socio-economic status categories. This study provides valuable insights for policymakers, healthcare professionals, and researchers, informing targeted interventions to enhance mental and behavioral health support for United States children.
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Affiliation(s)
- Emmanuel O Ilori
- Psychiatry and Behavioral Sciences, Garnet Health Medical Center, Middletown, USA
| | | | | | | | - Ogochukwu Agazie
- General Physician, College of Medicine, University of Lagos, Idi-Araba, NGA
| | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Lara Aderemi
- Family Medicine, University of Calgary, Calgary, CAN
| | - Mujeeb A Salawu
- Medicine and Surgery, University of Ilorin College of Health Sciences, Ilorin, NGA
- Internal Medicine and Psychiatry, Houston Health Department, Houston, USA
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Hughes PM, Graaf G, Gigli KH, deJong NA, McGrath RE, Thomas KC. Pediatric Mental Health Care and Scope-of-Practice Expansions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:384-392. [PMID: 38349470 PMCID: PMC11076160 DOI: 10.1007/s10488-024-01342-w] [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] [Accepted: 01/06/2024] [Indexed: 05/08/2024]
Abstract
To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.
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Affiliation(s)
- Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA.
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
| | - Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Kristin H Gigli
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
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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.
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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
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Musburger P, Olson E, Etow A, Camilleri C, Wong H, Witten MH, Kaminski JW. Examining State Licensing Requirements for Select Master's-Level Behavioral Health Providers for Children. Psychiatr Serv 2024:appips20230306. [PMID: 38616647 DOI: 10.1176/appi.ps.20230306] [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: 04/16/2024]
Abstract
OBJECTIVE The authors examined licensing requirements for select children's behavioral health care providers. METHODS Statutes and regulations as of October 2021 were reviewed for licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists for all 50 U.S. states and the District of Columbia. RESULTS All jurisdictions had laws regarding postgraduate training and license portability. No jurisdiction included language about specialized postgraduate training related to serving children and families or cultural competence. Other policies that related to the structure, composition, and authority of licensing boards varied across states and licensure types. CONCLUSIONS In their efforts to address barriers to licensure, expand the workforce, and ensure that children have access to high-quality and culturally responsive care, states could consider their statutes and regulations.
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Affiliation(s)
- Pratima Musburger
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Elizabeth Olson
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Alexis Etow
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Christine Camilleri
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Heather Wong
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Mary Helen Witten
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
| | - Jennifer W Kaminski
- ChangeLab Solutions, Oakland, California (Musburger, Olson, Etow, Camilleri, Wong); Child Development and Disability Branch (Witten) and Office of Policy, Performance, and Evaluation (Kaminski), Centers for Disease Control and Prevention (CDC), Atlanta
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O'Brien MJ, Pauls AM, Cates AM, Larson PD, Zorn AN. Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior. J Pediatr 2024:114056. [PMID: 38615943 DOI: 10.1016/j.jpeds.2024.114056] [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] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, through December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using non-parametric statistical analysis with odds ratios presented for significant factors. RESULTS Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least one psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA, USA; The University of Iowa Stead Family Department of Pediatrics, Iowa City, IA, USA.
| | | | | | - Priya D Larson
- The University of Iowa, Iowa City, IA, USA; The University of Iowa Department of Child and Adolescent Psychiatry, Iowa City, IA, USA
| | - Alithea N Zorn
- The University of Iowa, Iowa City, IA, USA; Center for Public Health Statistics, Iowa City, IA, USA; College of Public Health, Iowa City, IA, USA
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Hoffmann JA, Carter CP, Olsen CS, Ashby D, Bouvay KL, Duffy SJ, Chamberlain JM, Chaudhary SS, Glomb NW, Grupp-Phelan J, Haasz M, O'Donnell EP, Saidinejad M, Shihabuddin BS, Tzimenatos L, Uspal NG, Zorc JJ, Cook LJ, Alpern ER. Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study. Acad Emerg Med 2024. [PMID: 38563444 DOI: 10.1111/acem.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID-19 pandemic differed from expected prepandemic trends. METHODS We retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017-February 2020), early pandemic (March 2020-December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics. RESULTS We identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78-0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96-1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86-0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02-1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38-2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10-2.59), and substance-related and addictive disorders (RR 1.50, 95% CI 1.18-2.05). CONCLUSIONS During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - David Ashby
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kamali L Bouvay
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Susan J Duffy
- Department of Emergency Medicine, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA
| | - Sofia S Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nicolaus W Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Erin P O'Donnell
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohsen Saidinejad
- Department of Emergency Medicine, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bashar S Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | - Neil G Uspal
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Ansar N, Nissen Lie HA, Stiegler JR. The effects of emotion-focused skills training on parental mental health, emotion regulation and self-efficacy: Mediating processes between parents and children. Psychother Res 2024; 34:518-537. [PMID: 37311111 DOI: 10.1080/10503307.2023.2218539] [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: 10/07/2022] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023] Open
Abstract
Objective: Emotion-Focused Skills Training (EFST) is a short-term parental intervention based on humanistic principles. While studies have demonstrated the efficacy of EFST in alleviating child mental health symptoms, the mechanisms by which this happens is less clear. The present study investigated whether program participation led to improvements in the parents' own mental health, emotion regulation, and self-efficacy, and compared two versions of EFST: one experiential involving evocative techniques, and one psychoeducational involving didactic teaching of skills. Further, this study investigated whether improvements in parent outcomes mediated the effects on children's mental health. All parents received 2-days group training and 6 h of individual supervision. Methods: 313 parents (Mage = 40.5, 75.1% mothers) of 236 children (ages 6-13, 60.6% boys) with mental health difficulties within the clinical range and their teachers (N = 113, 82% female) were included. Participants were assessed at baseline, post-intervention, and 4-, 8- and 12-months follow-up. Results: Multilevel analysis showed significant improvements over time on all parental outcomes with large effects (drange0.6-1.1, ps < .001), with fathers benefitting more in terms of emotion regulation and self-efficacy (ps < .05). Significant differences were found between conditions on parental mental health and self-efficacy (all p's > .05). Cross-lagged panel models showed indirect effects of child symptoms at post-intervention on all parental outcomes at 12-months follow-up (βrange0.30-0.59, ps < .05). Bidirectional associations were observed between children's mental health symptoms and parental self-efficacy (βrange0.13-0.30, ps < .05). Conclusion: This study provides support for the effect of EFST on parent outcomes and the reciprocal relationship between the mental health of children's and their parents.Trial registration: ClinicalTrials.gov identifier: NCT03807336.
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Affiliation(s)
- Nadia Ansar
- Department of Research and Development, Norwegian Institute of Emotion-Focused Therapy, Bergen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Jan Reidar Stiegler
- Department of Research and Development, Norwegian Institute of Emotion-Focused Therapy, Bergen, Norway
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Schuchman M, Brady TM, Glenn DA, Tuttle KR, Cara-Fuentes G, Levy RV, Gonzalez-Vicente A, Alakwaa FM, Srivastava T, Sethna CB. Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies. J Nephrol 2024; 37:647-660. [PMID: 38512380 DOI: 10.1007/s40620-024-01919-6] [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: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies. METHODS An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes. RESULTS In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes. DISCUSSION/CONCLUSION Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.
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Affiliation(s)
- Matthew Schuchman
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Division of Nephrology, University of Washington School of Medicine, Spokane, WA, USA
| | - Gabriel Cara-Fuentes
- Section of Pediatric Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Rebecca V Levy
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Agustin Gonzalez-Vicente
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fadhl M Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI, USA
| | - Tarak Srivastava
- Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Christine B Sethna
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA.
- Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Ranjan JK, Kumari R, Choudhary A. Prevalence of attention deficit and hyperactive disorders in South Asian countries: A systematic review and meta-analysis of cross-sectional surveys from 1980 to 2023. Asian J Psychiatr 2024; 94:103970. [PMID: 38401384 DOI: 10.1016/j.ajp.2024.103970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Jay Kumar Ranjan
- Department of Psychology, Banaras Hindu University, Varanasi, India
| | - Rajbala Kumari
- Ranchi Women's College, Ranchi University, Ranchi, India
| | - Amrita Choudhary
- Department of Psychology, St. Xavier's University, Kolkata, India.
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Thakur H, Choi JW, Andrews AR, Temple JR, Cohen JR. Measurement of adolescent psychological wellbeing: A test of factor structure and measurement invariance. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 38561961 DOI: 10.1111/jora.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
Gains in holistic approaches to adult mental health have been associated with increasing interest in understanding psychological wellbeing (PWB) among adolescents. Empirical examination of measurement models for PWB in adolescence is lacking. Thus, the current study examined PWB in a longitudinal, diverse sample of 433 adolescents (non-Latinx Black: 37.6%; non-Latinx White: 25.9%; Latinx: 36.5%; Male adolescents: 50.1%). A one-factor, correlated six-factor and hierarchical models were examined across racial/ethnic (White, Black, and Hispanic) and gender (female, male) identities, after which the best fitting model was selected to undergo invariance testing. A one-factor structure was superior, and exhibited strict invariance across racial/ethnic and gender identities at each wave of the study, as well as longitudinal invariance within the entire sample.
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Affiliation(s)
- Hena Thakur
- Department of Psychology, University of Illinois at Urbana - Champaign, Champaign, Illinois, USA
| | - Jae Wan Choi
- Department of Psychology, University of Illinois at Urbana - Champaign, Champaign, Illinois, USA
| | - Arthur R Andrews
- Department of Psychology and Institute for Ethnic Studies, University of Nebraska - Lincoln, Lincoln, Nebraska, USA
| | - Jeff R Temple
- School of Behavioral Health Sciences, UTHealth, Houston, Texas, USA
| | - Joseph R Cohen
- Department of Psychology, University of Illinois at Urbana - Champaign, Champaign, Illinois, USA
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Eiland LS, Gildon BL. Diagnosis and Treatment of ADHD in the Pediatric Population. J Pediatr Pharmacol Ther 2024; 29:107-118. [PMID: 38596418 PMCID: PMC11001204 DOI: 10.5863/1551-6776-29.2.107] [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: 04/20/2023] [Accepted: 07/19/2023] [Indexed: 04/11/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood with approximately 6 million children (age 3 to 17 years) ever diagnosed based on data from 2016-2019. ADHD is characterized by a constant pattern of inattention and/or hyperactivity-impulsivity symptoms that interferes with development or functioning. Specific criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition Text Revision assist with the diagnosis with multiple guidelines available providing non-pharmacologic and pharmacologic recommendations for the treatment of ADHD in the pediatric population. While all guidelines similarly recommend behavioral and/or stimulant therapy as first-line therapy based on age, not all stimulant products are equal. Their differing pharmacokinetic profiles and formulations are essential to understand in order to optimize efficacy and safety for patients. Additionally, new stimulant products and non-stimulant medications continue to be approved for use of ADHD in the pediatric population and it is important to know their differences in formulation, efficacy, and safety to other products currently available. Lastly, due to drug shortages, it is important to understand product similarities and differences to select alternative therapy for patients.
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Affiliation(s)
- Lea S. Eiland
- Department of Pharmacy Practice (LSE), Auburn University Harrison College of Pharmacy
| | - Brooke L. Gildon
- Department of Pharmacy Practice (BLG), Southwestern Oklahoma State University College of Pharmacy
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Pollock JA. Telling the Stories of Neuroscientific Discovery to Schoolchildren and the Public Can Make an Impact. eNeuro 2024; 11:ENEURO.0078-24.2024. [PMID: 38594072 PMCID: PMC11005080 DOI: 10.1523/eneuro.0078-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- John A Pollock
- Department of Biological Sciences, School of Science & Engineering, Duquesne University, Pittsburgh, Pennsylvania 15282
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Kennedy KG, Ghugre NR, Roifman I, Qi X, Saul K, McCrindle BW, Macgowan CK, MacIntosh BJ, Goldstein BI. Impaired coronary microvascular reactivity in youth with bipolar disorder. Psychol Med 2024; 54:1196-1206. [PMID: 37905407 DOI: 10.1017/s0033291723003021] [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: 11/02/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. METHODS Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). RESULTS The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. CONCLUSION Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Xiuling Qi
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kayla Saul
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology & Artificial Intelligence (CRAI) unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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Reimann GE, Jeong HJ, Durham EL, Archer C, Moore TM, Berhe F, Dupont RM, Kaczkurkin AN. Gray matter volume associations in youth with ADHD features of inattention and hyperactivity/impulsivity. Hum Brain Mapp 2024; 45:e26589. [PMID: 38530121 DOI: 10.1002/hbm.26589] [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: 07/31/2023] [Revised: 11/30/2023] [Accepted: 12/26/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Prior research has shown smaller cortical and subcortical gray matter volumes among individuals with attention-deficit/hyperactivity disorder (ADHD). However, neuroimaging studies often do not differentiate between inattention and hyperactivity/impulsivity, which are distinct core features of ADHD. The present study uses an approach to disentangle overlapping variance to examine the neurostructural heterogeneity of inattention and hyperactivity/impulsivity dimensions. METHODS We analyzed data from 10,692 9- to 10-year-old children from the Adolescent Brain Cognitive Development (ABCD) Study. Confirmatory factor analysis was used to derive factors representing inattentive and hyperactive/impulsive traits. We employed structural equation modeling to examine these factors' associations with gray matter volume while controlling for the shared variance between factors. RESULTS Greater endorsement of inattentive traits was associated with smaller bilateral caudal anterior cingulate and left parahippocampal volumes. Greater endorsement of hyperactivity/impulsivity traits was associated with smaller bilateral caudate and left parahippocampal volumes. The results were similar when accounting for socioeconomic status, medication, and in-scanner motion. The magnitude of these findings increased when accounting for overall volume and intracranial volume, supporting a focal effect in our results. CONCLUSIONS Inattentive and hyperactivity/impulsivity traits show common volume deficits in regions associated with visuospatial processing and memory while at the same time showing dissociable differences, with inattention showing differences in areas associated with attention and emotion regulation and hyperactivity/impulsivity associated with volume differences in motor activity regions. Uncovering such biological underpinnings within the broader disorder of ADHD allows us to refine our understanding of ADHD presentations.
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Affiliation(s)
| | - Hee Jung Jeong
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - E Leighton Durham
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Camille Archer
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fanual Berhe
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Randolph M Dupont
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
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Midya V, Nagdeo K, Lane JM, Torres-Olascoaga LA, Torres-Calapiz M, Gennings C, Horton MK, Téllez-Rojo MM, Wright RO, Arora M, Eggers S. Prenatal metal exposures and childhood gut microbial signatures are associated with depression score in late childhood. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 916:170361. [PMID: 38278245 PMCID: PMC10922719 DOI: 10.1016/j.scitotenv.2024.170361] [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: 12/04/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Childhood depression is a major public health issue worldwide. Previous studies have linked both prenatal metal exposures and the gut microbiome to depression in children. However, few, if any, have studied their interacting effect in specific subgroups of children. OBJECTIVES Using an interpretable machine-learning method, this study investigates whether children with specific combinations of prenatal metals and childhood microbial signatures (cliques or groups of metals and microbes) were more likely to have higher depression scores at 9-11 years of age. METHODS We leveraged data from a well-characterized pediatric longitudinal birth cohort in Mexico City and its microbiome substudy (n = 112). Eleven metal exposures were measured in maternal whole blood samples in the second and third trimesters of pregnancy. The gut microbial abundances were measured at 9-11-year-olds using shotgun metagenomic sequencing. Depression symptoms were assessed using the Child Depression Index (CDI) t-scores at 9-11 years of age. We used Microbial and Chemical Exposure Analysis (MiCxA), which combines interpretable machine-learning into a regression framework to identify and estimate joint associations of metal-microbial cliques in specific subgroups. Analyses were adjusted for relevant covariates. RESULTS We identified a subgroup of children (11.6 % of the sample) characterized by a four-component metal-microbial clique that had a significantly high depression score (15.4 % higher than the rest) in late childhood. This metal-microbial clique consisted of high Zinc in the second trimester, low Cobalt in the third trimester, a high abundance of Bacteroides fragilis, a high abundance of Faecalibacterium prausnitzii. All combinations of cliques (two-, three-, and four-components) were significantly associated with increased log-transformed t-scored CDI (β = 0.14, 95%CI = [0.05,0.23], P < 0.01 for the four-component clique). SIGNIFICANCE This study offers a new approach to chemical-microbial analysis and a novel demonstration that children with specific gut microbiome cliques and metal exposures during pregnancy may have a higher likelihood of elevated depression scores.
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Affiliation(s)
- Vishal Midya
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kiran Nagdeo
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamil M Lane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Libni A Torres-Olascoaga
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mariana Torres-Calapiz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shoshannah Eggers
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA 2024; 331:850-860. [PMID: 38470385 PMCID: PMC10936112 DOI: 10.1001/jama.2024.0851] [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: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024]
Abstract
Importance Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk. Objective To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD. Design, Setting, and Participants In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first. Exposures ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis. Main Outcomes and Measures We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings). Results Of 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 individuals (95% CI, -17.3 to -0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 individuals; 95% CI, -14.2 to -0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 individuals; 95% CI, -6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05). Conclusions and Relevance Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.
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Affiliation(s)
- Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nanbo Zhu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health–School of Psychology, Faculty of Environmental and Life Sciences, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- New York University Child Study Center, Hassenfeld Children’s Hospital at NYU Langone, New York
- Solent NHS Trust, Southampton, United Kingdom
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari Aldo Moro, Bari, Italy
| | - Henrik Larsson
- School of medical sciences, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Lombard L. A vision to enhance self-regulation in children: The promise of pediatric hypnosis. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024:1-7. [PMID: 38447032 DOI: 10.1080/00029157.2024.2317790] [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: 03/08/2024]
Abstract
Pediatric hypnosis practices are a valuable tool for enhancing emotional self-regulation and promoting resilience. Hypnotically informed materials, toys, and language are simple ways to encourage relaxation and stress management. By learning hypnosis skills such as becoming imaginatively absorbed in imagery, "belly breathing," and using simple toys to promote muscle relaxation, children can access natural and novel ways to navigate life's challenges. An example of these hypnotically informed materials and skills training exercises can be found in Comfort Kits (developed by Dr. Karen Olness circa 1996 and widely distributed by Drs. Culbert and Olness since 2004, used by thousands of children in hospitals and in community settings following natural disasters and wars. Extending this supportive tool and self-hypnosis training into schools presents an opportunity to introduce children to self-directed stress management skills in a practical and convenient manner. Training children to use hypnotically informed self-regulation skills begins to fill the gap between the need for mental health services and available resources. By incorporating hypnotically informed stress management training and self-hypnosis practices into schools, we can equip children with essential tools for improved mental well-being, particularly when they need psychological first aid. Using hypnotic practices and skills can help children manage difficult experiences and develop a sense of comfort and control. Next steps include looking at the feasibility and efficacy of positioning self-directed self-regulation practices (like those found in Comfort Kits and used by clinicians trained in therapeutic pediatric hypnosis) in schools, including through consultation with experts in curriculum development and assessment.
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Patel A, Chavan R, Rakovski C, Beuttler R, Yang S. Changes in real-world dispensing of ADHD stimulants in youth from 2019 to 2021 in California. Front Public Health 2024; 12:1302144. [PMID: 38504685 PMCID: PMC10948562 DOI: 10.3389/fpubh.2024.1302144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurobehavioral disorders in the U.S. Stimulants, classified as controlled substances, are commonly used for ADHD management. We conducted an analysis of real-world stimulants dispensing data to evaluate the pandemic's impact on young patients (≤ 26 years) in California. Methods Annual prevalence of patients on stimulants per capita across various California counties from 2019 and 2021 were analyzed and further compared across different years, sexes, and age groups. New patients initiating simulants therapy were also examined. A case study was conducted to determine the impact of socioeconomic status on patient prevalence within different quintiles in Los Angeles County using patient zip codes. Logistic regression analysis using R Project was employed to determine demographic factors associated with concurrent use of stimulants with other controlled substances. Results There was a notable reduction in prevalence of patients ≤26 years old on stimulants during and after the pandemic per 100,000 people (777 in 2019; 743 in 2020; 751 in 2021). These decreases were more evident among the elementary and adolescent age groups. The most prevalent age group on stimulants were adolescents (12-17 years) irrespective of the pandemic. A significant rise in the number of female patients using stimulants was observed, increasing from 107,957 (35.2%) in 2019 to 121,241 (41.1%) in 2021. New patients initiating stimulants rose from 102,754 in 2020 to 106,660 in 2021, with 33.2% being young adults. In Los Angeles County, there was an increasing trend in patient prevalence from Q1 to Q5 income quintiles among patients ≥6 years. Consistently each year, the highest average income quintile exhibited the highest per capita prevalence. Age was associated with higher risk of concurrent use of benzodiazepines (OR, 1.198 [95% CI, 1.195-1.201], p < 0.0001) and opioids (OR, 1.132 [95% CI, 1.130-1.134], p < 0.0001) with stimulants. Discussion Our study provides real-world information on dispensing of ADHD stimulants in California youth from 2019 to 2021. The results underscore the importance of optimizing evidence-based ADHD management in pediatric patients and young adults to mitigate disparities in the use of stimulants.
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Affiliation(s)
- Anika Patel
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Rishikesh Chavan
- Hyundai Cancer Institute, CHOC Children’s Hospital, Orange, CA, United States
| | - Cyril Rakovski
- Schmid College of Science of Technology, Chapman University, Orange, CA, United States
| | - Richard Beuttler
- Chapman University School of Pharmacy, Irvine, CA, United States
| | - Sun Yang
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
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Schantell M, Taylor BK, Mansouri A, Arif Y, Coutant AT, Rice DL, Wang YP, Calhoun VD, Stephen JM, Wilson TW. Theta oscillatory dynamics serving cognitive control index psychosocial distress in youth. Neurobiol Stress 2024; 29:100599. [PMID: 38213830 PMCID: PMC10776433 DOI: 10.1016/j.ynstr.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/09/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background Psychosocial distress among youth is a major public health issue characterized by disruptions in cognitive control processing. Using the National Institute of Mental Health's Research Domain Criteria (RDoC) framework, we quantified multidimensional neural oscillatory markers of psychosocial distress serving cognitive control in youth. Methods The sample consisted of 39 peri-adolescent participants who completed the NIH Toolbox Emotion Battery (NIHTB-EB) and the Eriksen flanker task during magnetoencephalography (MEG). A psychosocial distress index was computed with exploratory factor analysis using assessments from the NIHTB-EB. MEG data were analyzed in the time-frequency domain and peak voxels from oscillatory maps depicting the neural cognitive interference effect were extracted for voxel time series analyses to identify spontaneous and oscillatory aberrations in dynamics serving cognitive control as a function of psychosocial distress. Further, we quantified the relationship between psychosocial distress and dynamic functional connectivity between regions supporting cognitive control. Results The continuous psychosocial distress index was strongly associated with validated measures of pediatric psychopathology. Theta-band neural cognitive interference was identified in the left dorsolateral prefrontal cortex (dlPFC) and middle cingulate cortex (MCC). Time series analyses of these regions indicated that greater psychosocial distress was associated with elevated spontaneous activity in both the dlPFC and MCC and blunted theta oscillations in the MCC. Finally, we found that stronger phase coherence between the dlPFC and MCC was associated with greater psychosocial distress. Conclusions Greater psychosocial distress was marked by alterations in spontaneous and oscillatory theta activity serving cognitive control, along with hyperconnectivity between the dlPFC and MCC.
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Affiliation(s)
- Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Brittany K. Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Amirsalar Mansouri
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Yasra Arif
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Anna T. Coutant
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Danielle L. Rice
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Yu-Ping Wang
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, USA
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging & Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | | | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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McCabe EM, Kaskoun J, Bennett S, Meadows-Oliver M, Schroeder K. Addressing School Connectedness, Belonging, and Culturally Appropriate Care for Newly Immigrated Students and Families. J Pediatr Health Care 2024; 38:233-239. [PMID: 38429035 PMCID: PMC10977599 DOI: 10.1016/j.pedhc.2023.10.001] [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: 08/06/2023] [Revised: 09/07/2023] [Accepted: 10/02/2023] [Indexed: 03/03/2024]
Abstract
School connectedness is the degree to which students experience acceptance, inclusion, and care by school personnel and peers. A sense of belonging incorporates an emotional connection to the community. School connectedness and belonging are protective factors that promote student engagement, accomplishment, and community performance. Despite the rise in students from immigrant families in the United States, belonging and connectedness for youth from diverse cultural and linguistic experiences are understudied. School-based nurses, our term, is inclusive of advanced practice pediatric, family, and psychiatric nurse practitioners, are well-positioned to support school connectedness for youth who may encounter hurdles to health care because of cultural and linguistic differences. We present practice suggestions for language, culture, and inclusion using three health conditions experienced by youth: anxiety, asthma, and obesity. School-based nurses and other school personnel who provide linguistic and culturally appropriate care can support students in feeling connected and included in their school communities.
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