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Galler A, Thönnes A, Joas J, Joisten C, Körner A, Reinehr T, Röbl M, Schauerte G, Siegfried W, Weghuber D, Weihrauch-Blüher S, Wiegand S, Holl RW, Prinz N. Clinical characteristics and outcomes of children, adolescents and young adults with overweight or obesity and mental health disorders. Int J Obes (Lond) 2024; 48:423-432. [PMID: 38195831 PMCID: PMC10896720 DOI: 10.1038/s41366-023-01449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Mental disorders are important comorbidities in youth with obesity. Aim was to describe the clinical characteristics and outcome of youth with overweight or obesity having comorbid mental disorders. METHODS Data from children, adolescents, and young adults (age 6-30 years) with overweight or obesity and mental disorders (depression, anxiety disorder, eating disorder, attention deficit disorder (ADHD)) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry (APV) were analyzed and compared with those without reported mental disorders using regression modeling. RESULTS Mental health comorbidity was reported in a total of 3969 out of 114,248 individuals with overweight or obesity: 42.5% had ADHD, 31.3% anxiety disorders, 24.3% depression, and 12.9% eating disorders. Being male (OR 1.39 (95%CI 1.27;1.52)), of older age (1.42 (1.25;1.62)), or with extreme obesity (1.45 (1.30;1.63)) were most strongly associated with mental health comorbidity. Regression analysis showed that mean BMI-SDS was significantly higher in the group of individuals with depression and eating disorders (BMI-SDS 2.13 (lower; upper mean:2.09;2.16) and 2.22 (2.17;2.26)) compared to those without reported mental health comorbidity (BMI-SDS 2.008 (2.005;2.011); p < 0.001). In youth with ADHD, BMI-SDS was lower compared to those without reported mental disorders (BMI-SDS 1.91 (1.89;1.93) vs 2.008 (2.005;2.011); p < 0.001). Proportion of severe obesity was higher in individuals with depression (23.7%), anxiety disorders (17.8%), and eating disorders (33.3%), but lower in ADHD (10.3%), compared to those without reported mental disorders (13.5%, p < 0.002). Proportions of dyslipidaemia and abnormal carbohydrate metabolism were not different in youth with and without reported mental health comorbidity. BMI-SDS change after one year of lifestyle intervention program ranged between -0.22 and -0.16 and was similar in youth without and with different mental disorders. CONCLUSION Health care professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders and regular mental health screening should be considered.
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Affiliation(s)
- Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany.
| | - Angelika Thönnes
- Universitätsklinikum des Saarlandes, Psychosomatische Medizin und Psychotherapie and Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Jens Joas
- Universitätsklinikum des Saarlandes, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Christine Joisten
- Deutsche Sporthochschule Köln, Institut für Bewegungs- und Neurowissenschaft, Köln, Germany
| | - Antje Körner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kinder- und Jugendmedizin, Leipzig, Germany
| | | | - Markus Röbl
- Universitätsmedizin Göttingen, Georg-August-Universität, Klinik für Kinder und Jugendmedizin, Göttingen, Germany
| | | | | | | | | | - Susanna Wiegand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Nicole Prinz
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Young AS, Findling RL, Riehm KE, Seegan P, Crum RM, Mojtabai R, Chiappini EA, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Horwitz SM. Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics. Psychiatr Serv 2023; 74:1218-1226. [PMID: 37287230 PMCID: PMC10983772 DOI: 10.1176/appi.ps.20220375] [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: 06/09/2023]
Abstract
OBJECTIVE An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. METHODS Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. RESULTS Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. CONCLUSIONS The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Kira E Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Paige Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Rosa M Crum
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Erika A Chiappini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Eric A Youngstrom
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Boris Birmaher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Sarah M Horwitz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
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Hansen BH, Andresen HN, Gjesvik J, Thorsby PM, Naerland T, Knudsen-Heier S. Associations between psychiatric comorbid disorders and executive dysfunctions in hypocretin-1 deficient pediatric narcolepsy type1. Sleep Med 2023; 109:149-157. [PMID: 37442017 DOI: 10.1016/j.sleep.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE/BACKGROUND Psychiatric symptoms and cognitive deficits add significantly to impairment in academic achievement and quality of life in patients with narcolepsy. The primary aim of this study was to evaluate the prevalence of psychiatric disorders and executive dysfunctions, secondly to explore the association between psychiatric comorbidity, executive dysfunctions, subjective and objective sleep measures, and severity of cerebrospinal fluid (CSF) hypocretin-1 deficiency in pediatric narcolepsy type 1 (PNT1). PATIENTS/METHODS Cross-sectional study of 59 consecutively included PNT1 patients (age: 6-20 years; 34:25 girls: boys; 54/59 H1N1 (Pandemrix®)-vaccinated). Core narcolepsy symptoms including subjective sleepiness, polysomnography and multiple sleep latency test results, CSF hypocretin-1 levels, psychiatric disorders (by semistructured diagnostic interview Kaufmann Schedule for Affective Disorders and Schizophrenia Present and Lifetime version (KSADS)), and executive dysfunction (by Behavior Rating of Executive Function (BRIEF)) were assessed. RESULTS 52.5% of the patients had one or more psychiatric comorbid disorder, and 64.7% had executive dysfunction in a clinically relevant range, with no sex difference in prevalence, while older age was associated with poorer executive function (p=0.013). Having any psychiatric comorbid disorder was associated with poorer executive functions (p=0.001). CSF hypocretin-1 deficiency severity was significantly associated with presence of psychiatric comorbidity (p=0.022) and poorer executive functions (p=0.030), and poorer executive functions was associated with subjective sleepiness (p=0.009). CONCLUSIONS The high occurrence of, and association between, psychiatric comorbidity and executive dysfunction underlines the importance of close attention to both these comorbidities in clinical care of NT1.
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Affiliation(s)
- Berit Hjelde Hansen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway.
| | | | | | - Per M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Terje Naerland
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Abstract
Obsessive-compulsive disorder (OCD) is characterized by time-consuming, distressing, or impairing obsessions and compulsions. Obsessions are recurrent, persistent, and intrusive thoughts, urges, or images. Compulsions are repetitive and often ritualized behaviors or mental acts performed to manage obsession-related distress or prevent harm. OCD affects 1% to 3% of the population, typically begins during adolescence or early adulthood, and can have a chronic or deteriorating course in the absence of effective treatment.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund SE-22241, Sweden.
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5
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Arnardóttir A, Skarphedinsson G. Comparative effectiveness of cognitive behavioral treatment, serotonin, and serotonin noradrenaline reuptake inhibitors for anxiety in children and adolescents: a network meta-analysis. Nord J Psychiatry 2023; 77:118-126. [PMID: 35507829 DOI: 10.1080/08039488.2022.2069858] [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: 10/18/2022]
Abstract
AIM Cognitive behavioral treatment (CBT) and selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for childhood anxiety disorders (ADs). The objective of this current analysis was to conduct a network meta-analysis to evaluate the comparative effectiveness of CBT, pharmacotherapy, and the combination of the two in treating pediatric ADs. METHODS The studies included consisted of randomized controlled trials evaluating non-selective serotonin reuptake inhibitors (e.g. clomipramine), SSRIs, selective noradrenaline reuptake inhibitors, CBT, or a combination of CBT and pharmacotherapy. Studies were eligible for inclusion if participants were 18 years or younger. RESULTS A total of 86 studies were included, with a total of 7594 participants, of which 41.51% were females. For remission, all three treatments were significantly more effective than both placebo (ORs ranging from 0.07 and 0.18) and wait-list (ORs ranging from 0.06 and 0.16). In terms of the severity of anxiety symptoms, all treatment forms were significantly more effective for reducing anxiety than wait-list (standardized mean differences (SMDs) ranging from 0.98 and 2.91). Only pharmacotherapy was significantly more effective in reducing anxiety symptoms than placebo (SMD = 2.01, 95% confidence interval, 1.02 to 3.01). Overall, the results demonstrate that CBT, pharmacotherapy, and their combination are effective treatments for childhood ADs. There was no significant difference between the three treatment forms. However, CBT was associated with lower attrition rates. CONCLUSION CBT, pharmacotherapy, and the combination of the two should all be considered to treat youths with ADs. However, potential risks and benefits should be considered before devising a treatment plan.
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Aydin S, Crone MR, Siebelink BM, Numans ME, Vermeiren RRJM, Westenberg PM. Informative value of referral letters from general practice for child and adolescent mental healthcare. Eur Child Adolesc Psychiatry 2023; 32:303-315. [PMID: 34417876 PMCID: PMC9970945 DOI: 10.1007/s00787-021-01859-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.
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Affiliation(s)
- S Aydin
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands.
| | - M R Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - B M Siebelink
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - R R J M Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
- Youz, Parnassia Group, Rotterdam, The Netherlands
| | - P M Westenberg
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
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Trbovich AM, Preszler J, Emami K, Cohen P, Eagle S, Collins MW, Kontos AP. Is Overparenting Associated with Adolescent/Young Adult Emotional Functioning and Clinical Outcomes Following Concussion? Child Psychiatry Hum Dev 2022; 53:1231-1239. [PMID: 34136979 DOI: 10.1007/s10578-021-01204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Overparenting (O-P), or "helicopter" parenting, has warranted increased attention across the past decade. It is characterized as being overly involved, protective, and low on granting autonomy, and is associated with deleterious psychosocial outcomes outside of the concussion literature. This study examined the association of overparenting and patient emotional distress and clinical outcomes (i.e., symptoms, neurocognitive test scores, recovery time) post-concussion. Adolescents/young adult concussion patients (injury < 30 days) and parents (N = 101 child-parent dyads) participated. Patient participants completed measures of depression, anxiety, stress, and concussion clinical outcomes while parents concurrently completed an overparenting measure. Results of a general linear model found that overparenting was associated with higher anxiety and stress report of the child. Overparenting had a significant positive correlation with concussion recovery, although of a small magnitude. Emotional distress level, but not overparenting, was moderately associated with worse performance on clinical outcomes, including neurocognitive testing, vestibular/ocular motor dysfunction, and concussion symptom severity.
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Affiliation(s)
- Alicia M Trbovich
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA.
| | - Jonathan Preszler
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Kouros Emami
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Paul Cohen
- WakeMed Concussion Program, WakeMed Health and Hospitals, 3000 New Bern Ave, Raleigh, NC, 27610, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
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Jónsdóttir H, Agnarsdóttir H, Jóhannesdóttir H, Smárason O, Harðardóttir HH, Højgaard DRMA, Skarphedinsson G. Parent-youth agreement on psychiatric diagnoses and symptoms: results from an adolescent outpatient clinical sample. Nord J Psychiatry 2022; 76:466-473. [PMID: 34792428 DOI: 10.1080/08039488.2021.2002405] [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: 10/19/2022]
Abstract
OBJECTIVE Previous research suggests that agreement, between youths and their parents, regarding assessment of youth psychiatric problems is limited. Due to this discrepancy, a multi-informant, multimethod approach is recommended when gathering psychopathological information. This study examines parent-youth agreement regarding youth psychiatric problems. It does so at a diagnostic level and at a symptom level, as well as studying the influence of age, gender, depressive disorder, anxiety disorder and attention-deficit/hyperactivity disorder (ADHD) as potential moderators of agreement. METHODS The participants in this study were 61 adolescents aged 12-18 years and their parents. The K-SADS-PL DSM-5 was administered in two outpatient units, with adolescents and their parents interviewed separately. Participants also rated symptoms using a broad rating scale (Child Behavior Checklist and the Youth Self-Report) prior to being interviewed. RESULTS Parent-youth agreement at a diagnostic level ranged from fair to excellent. Agreement at a symptom level was lower than that at a diagnostic level, ranging from poor to fair. These results indicate that parent-youth agreement regarding diagnosis and symptoms is higher than in most previous studies. The results also suggest that some variables, such as age, gender, depressive disorders, and ADHD, potentially influence agreement on symptoms. CONCLUSION These findings support the importance of gathering information from both children and parents, and that clinicians should consider moderating factors when integrating data from multiple informants.
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Affiliation(s)
- Helga Jónsdóttir
- Centre for Child Development and Behavior for the Primary Health Care of the Capital Area, Reykjavik, Iceland
| | - Hrafnkatla Agnarsdóttir
- Department of Child and Adolescent Psychiatry, Landspítali University Hospital, Reykjavík, Iceland
| | | | | | | | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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9
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Giani L, Caputi M, Forresi B, Michelini G, Scaini S. Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Skarphedinsson G, Jarbin H, Andersson M, Ivarsson T. Diagnostic efficiency and validity of the DSM-oriented Child Behavior Checklist and Youth Self-Report scales in a clinical sample of Swedish youth. PLoS One 2021; 16:e0254953. [PMID: 34293000 PMCID: PMC8297893 DOI: 10.1371/journal.pone.0254953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022] Open
Abstract
The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) are widely used measures of psychiatric symptoms and lately also adapted to the DSM. The incremental validity of adding the scales to each other has not been studied. We validated the DSM subscales for affective, anxiety, attention deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct problems (CD), and obsessive-compulsive disorder (OCD) in consecutively referred child and adolescent psychiatric outpatients (n = 267) against LEAD DSM-IV diagnoses based on the K-SADS-PL and subsequent clinical work-up. Receiver operating characteristic analyses showed that the diagnostic efficiency for most scales were moderate with an area under the curve (AUC) between 0.70 and 0.90 except for CBCL CD, which had high accuracy (AUC>0.90) in line with previous studies showing the acceptable utility of the CBCL DSM scales and the YSR affective, anxiety, and CD scales, while YSR ODD and OCD had low accuracy (AUC<0.70). The findings mostly reveal incremental validity (using logistic regression analyses) for adding the adolescent to the parent version (or vice versa). Youth and parent ratings contributed equally to predict depression and anxiety disorders, while parent ratings were a stronger predictor for ADHD. However, the youth ADHD rating also contributed. Adding young people as informants for ODD and OCD or adding the parent for CD did not improve accuracy. The findings for depression, anxiety disorders, and ADHD support using more than one informant when conducting screening in a clinical context.
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Affiliation(s)
| | - Håkan Jarbin
- Child and Adolescent Psychiatry, Region Halland, Halland, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Markus Andersson
- Child and Adolescent Psychiatry, Region Halland, Halland, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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11
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The Use of Evidence-Based Assessment for Anxiety Disorders in an Australian Sample. J Anxiety Disord 2020; 75:102279. [PMID: 32777601 DOI: 10.1016/j.janxdis.2020.102279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Anxiety disorders are common and cause considerable functional impairment. Fortunately, evidence-based treatments are available, however, treatment effectiveness is often reliant on the provision of an accurate diagnosis. Accurate diagnosis requires a multi-method evidence-based assessment (EBA). Assessment techniques available to clinicians include a clinical interview, semi-structured diagnostic interview, self-report/clinician-administered rating scales and direct observation. Research demonstrates that only a small number of therapists utilize EBA, and to date this has not been investigated in an Australian sample. One hundred and two registered Australian psychologists (Mage = 40.98; SD = 12.67; 83.6% female) participated in an online study investigating assessment practices. Participants were asked to indicate EBA frequency of use and the obstacles they face to using EBA. The majority of participants (69% working with adult patients and 51% working with pediatric patients) reported partial use of EBA. Few psychologists (21% working with adult patients and 11% working with child patients) indicated complete use of EBA. Thirty-six percent of participants indicated negative beliefs about the usefulness or helpfulness of EBA. Multiple obstacles to the use of EBA were reported including concerns with the time required to complete assessment (27%), and a lack of access to assessment tools (10%). Implications for training and clinical practice are discussed.
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12
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Sigurvinsdóttir AL, Jensínudóttir KB, Baldvinsdóttir KD, Smárason O, Skarphedinsson G. Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:168-180. [PMID: 31738631 DOI: 10.1080/08039488.2019.1686653] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.
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Affiliation(s)
| | | | | | - Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.,Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
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13
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Liu CH, Li H, Wu E, Tung ES, Hahm HC. Parent perceptions of mental illness in Chinese American youth. Asian J Psychiatr 2020; 47:101857. [PMID: 31715469 PMCID: PMC7056581 DOI: 10.1016/j.ajp.2019.101857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth. METHODS Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking. RESULTS While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences. DISCUSSION These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.
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Affiliation(s)
- Cindy H Liu
- Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Huijun Li
- Florida A&M University, 1601 S. Martin Luther King Jr Blvd, Tallahassee, FL 32307, USA.
| | - Emily Wu
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Esther S Tung
- Department of Psychology, Boston University, 900 Commonwealth Ave. Floor 2, Boston, MA 02215, USA.
| | - Hyeouk C Hahm
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, USA.
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14
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Wesselhoeft R, Jensen PB, Talati A, Reutfors J, Furu K, Strandberg-Larsen K, Damkier P, Pottegård A, Bliddal M. Trends in antidepressant use among children and adolescents: a Scandinavian drug utilization study. Acta Psychiatr Scand 2020; 141:34-42. [PMID: 31618447 DOI: 10.1111/acps.13116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare antidepressant utilization in individuals aged 5-19 years from the Scandinavian countries. METHODS A population-based drug utilization study using publicly available data of antidepressant use from Denmark, Norway, and Sweden. RESULTS In the study period from 2007 to 2017, the proportion of antidepressant users increased markedly in Sweden (9.3-18.0/1000) compared to Norway (5.1-7.6/1000) and Denmark (9.3-7.5/1000). In 2017, the cumulated defined daily doses (DDD) of selective serotonin reuptake inhibitors were 5611/1000 inhabitants in Sweden, 2709/1000 in Denmark, and 1848/1000 in Norway. The use of 'other antidepressants' (ATC code N06AX) also increased in Sweden with a higher DDD in 2017 (497/1000) compared to Denmark (225/1000) and Norway (170/1000). The use of tricyclic antidepressants was generally low in 2017 with DDDs ranging between 30-42 per 1000. The proportion of antidepressant users was highest among 15- to 19-year-old individuals. Girls were more likely to receive treatment than boys, and the treated female/male ratios per 1000 were similar in Sweden (2.39), Denmark (2.44), and Norway (2.63). CONCLUSION Even in highly comparable healthcare systems like the Scandinavian countries', variation in antidepressant use is considerable. Swedish children and adolescents have a markedly higher and still increasing use of antidepressants compared to Danish and Norwegian peers.
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Affiliation(s)
- R Wesselhoeft
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research Unit of Child and Adolescent Mental Health, Department of Clinical Research, University of Southern, Odense, Denmark
| | - P B Jensen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Talati
- Department of Psychiatry, Division of Epidemiology, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | - J Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - K Furu
- Department of Chronic Diseases and Ageing and Centre for Fertility & Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - P Damkier
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M Bliddal
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern, Odense, Denmark.,Odense University Hospital, Odense, Denmark
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15
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McKinnon A, Keers R, Coleman JR, Lester KJ, Roberts S, Arendt K, Bögels SM, Cooper P, Creswell C, Hartman CA, Fjermestad KW, In‐Albon T, Lavallee K, Lyneham HJ, Smith P, Meiser‐Stedman R, Nauta MH, Rapee RM, Rey Y, Schneider S, Silverman WK, Thastum M, Thirlwall K, Wergeland GJ, Eley TC, Hudson JL. The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders. J Child Psychol Psychiatry 2018; 59. [PMID: 29520926 PMCID: PMC6055633 DOI: 10.1111/jcpp.12872] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment formats. METHODS A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question. RESULTS In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-up data were examined separately. CONCLUSIONS Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required.
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Affiliation(s)
- Anna McKinnon
- Department of PsychologyCentre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
| | - Robert Keers
- Department of Biological and Experimental PsychologySchool of Biological and Chemical SciencesQueen Mary University of LondonLondonUK
| | - Jonathan R.I. Coleman
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,NIHR Biomedical Research Centre for Mental HealthSouth London and Maudsley NHS TrustLondonUK
| | | | - Susanna Roberts
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Kristian Arendt
- Department of Psychology and Behavioural SciencesAarhus UniversityAarhusDenmark
| | - Susan M. Bögels
- Research Institute Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Peter Cooper
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK,Department of PsychologyStellenbosch UniversityStellenboschSouth Africa,Department of PsychologyThe University of Cape TownCape TownSouth Africa
| | - Cathy Creswell
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Catharina A. Hartman
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Krister W. Fjermestad
- Department of Clinical PsychologyFaculty of PsychologyUniversity of BergenBergenNorway,Department of Child and Adolescent PsychiatryAnxiety Disorders Research NetworkHaukeland University HospitalBergenNorway
| | - Tina In‐Albon
- Department of PsychologyUniversity Landau KoblenzLandauGermany
| | | | - Heidi J. Lyneham
- Department of PsychologyCentre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
| | - Patrick Smith
- Department of PsychologyInstitute of PsychiatryKing's College LondonLondonUK
| | | | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Ronald M. Rapee
- Department of PsychologyCentre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
| | - Yasmin Rey
- Department of PsychologyChild Anxiety and Phobia ProgramFlorida International UniversityMiamiFLUSA
| | | | | | - Mikael Thastum
- Department of Psychology and Behavioural SciencesAarhus UniversityAarhusDenmark
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Gro Janne Wergeland
- Department of Child and Adolescent PsychiatryAnxiety Disorders Research NetworkHaukeland University HospitalBergenNorway
| | - Thalia C. Eley
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,NIHR Biomedical Research Centre for Mental HealthSouth London and Maudsley NHS TrustLondonUK
| | - Jennifer L. Hudson
- Department of PsychologyCentre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
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16
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Hansen BH, Oerbeck B, Skirbekk B, Petrovski BÉ, Kristensen H. Neurodevelopmental disorders: prevalence and comorbidity in children referred to mental health services. Nord J Psychiatry 2018; 72:285-291. [PMID: 29488416 DOI: 10.1080/08039488.2018.1444087] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accurate prevalence rates of the neurodevelopmental disorders (ND) and comorbid conditions in child and adolescent mental health services (CAMHS) are essential for treatment planning and organization of health care. However, valid and reliable prevalence estimates from Nordic CAMHS populations are scarce, and the published findings vary. AIMS To report prevalence rates of ND (attention-deficit hyperactivity disorder: ADHD, tic disorder: TD or autism spectrum disorder: ASD) and comorbid disorders by a validated diagnostic instrument in children referred to CAMHS outpatient clinics. METHODS Parents of 407 consecutively referred children aged 7-13 years were interviewed with the semistructured interview schedule for affective disorders and schizophrenia, present and lifetime version (Kiddie-SADS-PL) at time of admittance. RESULTS One or more ND was diagnosed in 226 children (55.5%; 69.9% boys): ADHD (44.5%; 68.5% boys); TD (17.7%; 77.8% boys) and ASD (6.1%; 76% boys). Among children with ND 70 (31.0%) had only one ND with no comorbid disorder, 49 (21.7%) had more than one ND (homotypic comorbidity) and 131 (58%) had a non-ND psychiatric disorder (heterotypic comorbidity). Anxiety disorders were the most frequently occurring heterotypic comorbidity in all three ND. Comorbid depressive disorder was associated with older age, and comorbid anxiety disorder with female gender. CONCLUSION In children referred to CAMHS, ND constitute the most frequently occurring group of disorders, with high rates of both homotypic and heterotypic comorbidity. This needs to be taken into consideration in health service planning and treatment delivery.
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Affiliation(s)
- Berit Hjelde Hansen
- a BUP Nedre Romerike, Division of Mental Health , Akershus University Hospital , Lørenskog , Norway.,b Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Beate Oerbeck
- d Department of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway
| | | | - Beáta Éva Petrovski
- f Health Services Research Center (HØKH) , Akershus University Hospital , Lørenskog , Norway
| | - Hanne Kristensen
- g Center for Child and Adolescent Mental Health , Eastern and Southern Norway , Oslo , Norway
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17
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Ivarsson T, Skarphedinsson G, Andersson M, Jarbin H. The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth. Child Psychiatry Hum Dev 2018; 49:234-243. [PMID: 28756556 PMCID: PMC5856859 DOI: 10.1007/s10578-017-0746-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children's Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.
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Affiliation(s)
- Tord Ivarsson
- The Centre for Child and Adolescent Mental Health, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | | | - Markus Andersson
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden ,Region Halland, Sweden. BUP, HSH, SE-301 85 Halmstad, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden ,Region Halland, Sweden. BUP, HSH, SE-301 85 Halmstad, Sweden
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18
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Becker-Haimes EM, Okamura K, Wolk CB, Rubin R, Evans AC, Beidas RS. Predictors of clinician use of exposure therapy in community mental health settings. J Anxiety Disord 2017; 49:88-94. [PMID: 28475946 PMCID: PMC5501186 DOI: 10.1016/j.janxdis.2017.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/26/2017] [Indexed: 12/21/2022]
Abstract
Exposure therapy is recognized as the key component of cognitive-behavioral treatment for anxiety. However, exposure is the least used evidence-based treatment in community mental health settings and is the most challenging technique for clinicians to adopt within the context of effectiveness and implementation trials. Little work has examined clinician and organizational characteristics that predict use of exposure, which is important for identifying implementation strategies that may increase its use. In a large sample of community health clinicians (N=335) across 31 clinical practice sites, this study characterized clinician and organizational predictors of exposure use and relaxation for anxiety. Mixed effects regression analyses indicated that both clinician attitudes and an organization's implementation climate may be important levers for interventions seeking to increase clinician exposure use. Greater clinician use of relaxation strategies was also associated with less exposure use. Results point to important implications for implementing cognitive-behavioral therapy for anxiety, including de-emphasizing relaxation and attending to organizational climate.
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Affiliation(s)
- Emily M. Becker-Haimes
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759,Corresponding author, Rinad S. Beidas, , phone: 215-746-1759, fax: 215-349-8715 3535 Market Street, 3rd Floor Philadelphia, PA 19104
| | - Kelsie Okamura
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759
| | - Courtney Benjamin Wolk
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Ronnie Rubin
- Department of Behavioral Health and Intellectual Disability Services, 1101 Market St. Philadelphia, PA 19107, USA.
| | - Arthur C. Evans
- Department of Behavioral Health and Intellectual disAbility Services, 1101 Market St. Philadelphia, PA 19107
| | - Rinad S. Beidas
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 floor, Philadelphia, PA 19104, USA, 215-746-1759
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19
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Olofsdotter S, Vadlin S, Sonnby K, Furmark T, Nilsson KW. Anxiety Disorders among Adolescents referred to General Psychiatry for Multiple Causes: Clinical Presentation, Prevalence, and Comorbidity. Scand J Child Adolesc Psychiatr Psychol 2016. [DOI: 10.21307/sjcapp-2016-010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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