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Herbert K, Herlitz L, Woodman J, Powell C, Morris S. Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review. BMJ Open 2024; 14:e078505. [PMID: 38760051 PMCID: PMC11103219 DOI: 10.1136/bmjopen-2023-078505] [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: 08/03/2023] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use in the UK, taking into account underlying healthcare needs? DESIGN: Scoping review. SETTING Primary care. ELIGIBILITY CRITERIA English-language quantitative or mixed-methods studies published between 2012 and 2022. DATA SOURCES Medline, Embase, Scopus and Web of Science Social Sciences Citation Index, and grey literature. RESULTS 22 eligible studies were identified, covering general practice (n=14), dental health (n=4), child mental health (MN) services (n=3) and immunisation (n=1). Only eight studies (36%) controlled for variables associated with healthcare need (eg, age, birth weight and long-term conditions). In these, evidence of horizontal inequity in primary care use was reported for CYP living in deprived areas in England, with and without complex needs. Horizontal inequity was also identified in primary care MN referrals for CYP in England identifying as mixed-race, Asian or black ethnicity, compared with their white British peers. No evidence of horizontal inequity was observed, however, in primary care use for CYP in England exposed to parental depression, or for CYP children from low-income households in Scotland. Increasing CYP's age was associated with decreasing primary care use across included studies. No studies were found regarding CYP from Gypsy or Traveller communities, children in care, or those with disabilities or special educational needs. CONCLUSIONS There is evidence that socioeconomic factors impact on CYP's primary care use, in particular age, ethnicity and deprivation. However, better quality evidence is required to evaluate horizontal inequity in use and address knowledge gaps regarding primary care use for vulnerable CYP populations and the impact of policy and practice related 'supply side' of primary care.
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Affiliation(s)
- Kevin Herbert
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lauren Herlitz
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Jenny Woodman
- Institute of Education, UCL Social Research Institute, London, UK
| | - Claire Powell
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Stephen Morris
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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Bevan Jones R, Hussain F, Agha SS, Weavers B, Lucassen M, Merry S, Stallard P, Simpson SA, Rice F. Digital technologies to support adolescents with depression and anxiety: review. BJPSYCH ADVANCES 2023; 29:239-253. [PMID: 37521105 PMCID: PMC10374830 DOI: 10.1192/bja.2022.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 01/21/2023]
Abstract
Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents' access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.
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Affiliation(s)
- Rhys Bevan Jones
- Senior Clinical Research Fellow in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, and a psychiatrist with Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Faris Hussain
- Academic Foundation Year 2 doctor with Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Sharifah Shameem Agha
- Lecturer with Cwm Taf Morgannwg University Health Board and an honorary lecturer in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| | - Bryony Weavers
- Research assistant in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| | - Mathijs Lucassen
- Senior lecturer in mental health in the Department of Health and Social Care, The Open University, UK, and an honorary senior lecturer in psychological medicine at the University of Auckland, New Zealand
| | - Sally Merry
- Professor in Child and Adolescent Mental Health in the Faculty of Medical and Health Sciences at the University of Auckland, New Zealand
| | - Paul Stallard
- Professor of Child and Family Mental Health in the Department for Health at the University of Bath, England, UK
| | - Sharon Anne Simpson
- Professor of Behavioural Sciences and Health in the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow, Scotland, UK
| | - Frances Rice
- Professor of Developmental Psychopathology in the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
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Bevan Jones R, Merry S, Stallard P, Randell E, Weavers B, Gray A, Hindle E, Gavigan M, Clarkstone S, Williams-Thomas R, Poile V, Playle R, Bisson JI, McNamara R, Rice F, Simpson SA. Further development and feasibility randomised controlled trial of a digital programme for adolescent depression, MoodHwb: study protocol. BMJ Open 2023; 13:e070369. [PMID: 37277220 PMCID: PMC10254867 DOI: 10.1136/bmjopen-2022-070369] [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: 11/26/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION A digital programme, MoodHwb, was codesigned with young people experiencing or at high risk of depression, parents/carers and professionals, to provide support for young people with their mood and well-being. A preliminary evaluation study provided support for the programme theory and found that MoodHwb was acceptable to use. This study aims to refine the programme based on user feedback, and to assess the acceptability and feasibility of the updated version and study methods. METHODS AND ANALYSIS Initially, this study will refine MoodHwb with the involvement of young people, including in a pretrial acceptability phase. This will be followed by a multicentre feasibility randomised controlled trial comparing MoodHwb plus usual care with a digital information pack plus usual care. Up to 120 young people aged 13-19 years with symptoms of depression and their parents/carers will be recruited through schools, mental health services, youth services, charities and voluntary self-referral in Wales and Scotland. The primary outcomes are the feasibility and acceptability of the MoodHwb programme (including usage, design and content) and of trial methods (including recruitment and retention rates), assessed 2 months postrandomisation. Secondary outcomes include potential impact on domains including depression knowledge and stigma, help-seeking, well-being and depression and anxiety symptoms measured at 2 months postrandomisation. ETHICS AND DISSEMINATION The pretrial acceptability phase was approved by the Cardiff University School of Medicine Research Ethics Committee (REC) and the University of Glasgow College of Medicine, Veterinary and Life Sciences REC. The trial was approved by Wales NHS REC 3 (21/WA/0205), the Health Research Authority(HRA), Health and Care Research Wales (HCRW), university health board Research and Development (R&D) departments in Wales, and schools in Wales and Scotland. Findings will be disseminated in peer-reviewed open-access journals, at conferences and meetings, and online to academic, clinical, and educational audiences and the wider public. TRIAL REGISTRATION NUMBER ISRCTN12437531.
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Affiliation(s)
- Rhys Bevan Jones
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales
- Cwm Taf Morgannwg University Health Board, Rhondda Cynon Taf, Wales
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales
| | - Sally Merry
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Paul Stallard
- Department for Health, University of Bath, Bath, England
| | | | - Bryony Weavers
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales
| | - Anna Gray
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales
| | - Elaine Hindle
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Marcela Gavigan
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | | | | | - Vince Poile
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
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Stephens A, Allardyce J, Weavers B, Lennon J, Jones RB, Powell V, Eyre O, Potter R, Price VE, Osborn D, Thapar A, Collishaw S, Thapar A, Heron J, Rice F. Developing and validating a prediction model of adolescent major depressive disorder in the offspring of depressed parents. J Child Psychol Psychiatry 2023; 64:367-375. [PMID: 36096685 PMCID: PMC10087673 DOI: 10.1111/jcpp.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parental depression is common and is a major risk factor for depression in adolescents. Early identification of adolescents at elevated risk of developing major depressive disorder (MDD) in this group could improve early access to preventive interventions. METHODS Using longitudinal data from 337 adolescents at high familial risk of depression, we developed a risk prediction model for adolescent MDD. The model was externally validated in an independent cohort of 1,384 adolescents at high familial risk. We assessed predictors at baseline and MDD at follow-up (a median of 2-3 years later). We compared the risk prediction model to a simple comparison model based on screening for depressive symptoms. Decision curve analysis was used to identify which model-predicted risk score thresholds were associated with the greatest clinical benefit. RESULTS The MDD risk prediction model discriminated between those adolescents who did and did not develop MDD in the development (C-statistic = .783, IQR (interquartile range) = .779, .778) and the validation samples (C-statistic = .722, IQR = -.694, .741). Calibration in the validation sample was good to excellent (calibration intercept = .011, C-slope = .851). The MDD risk prediction model was superior to the simple comparison model where discrimination was no better than chance (C-statistic = .544, IQR = .536, .572). Decision curve analysis found that the highest clinical utility was at the lowest risk score thresholds (0.01-0.05). CONCLUSIONS The developed risk prediction model successfully discriminated adolescents who developed MDD from those who did not. In practice, this model could be further developed with user involvement into a tool to target individuals for low-intensity, selective preventive intervention.
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Affiliation(s)
- Alice Stephens
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Judith Allardyce
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bryony Weavers
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jessica Lennon
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhys Bevan Jones
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Victoria Powell
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert Potter
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Valentina Escott Price
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Anita Thapar
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Ajay Thapar
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| | - Frances Rice
- Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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Dülsen P, Barck K, Daubmann A, Höller A, Zeidler J, Kilian R, Wiegand-Grefe S, Baumeister H. Clinical- and Cost Effectiveness of a Guided Internet-Based Intervention for Children (12–18 Years) of Parents With Mental Disorders (iCHIMPS): Study Protocol of a Multicentered Cluster-Randomized Controlled Trial. Front Digit Health 2022; 4:816412. [PMID: 35252960 PMCID: PMC8888925 DOI: 10.3389/fdgth.2022.816412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionChildren of parents with mental disorders have a high chance of developing a mental disorder themselves. However, this at-risk group is regularly overlooked and typically not seen by any mental health professionals. Internet- and mobile-based interventions (IMIs) can provide a means of promoting mental health for children of parents with mental disorders.ObjectiveThe introduced study will evaluate the clinical- and cost-effectiveness of the iCHIMPS IMI in promoting mental health for children of parents with mental disorders.MethodsA two-armed multicentered cluster-randomized controlled trial (cRCT) comparing the clinical- and cost-effectiveness of the iCHIMPS IMI in the intervention group (IG) to a treatment-as-usual (TAU) control group will be conducted. Recruitment will be handled at currently 21 adult mental health clinics throughout Germany. Participating families will be randomly divided into the two groups until the final sample size of 306 participating adolescents (age 12–18) has been reached. The adolescents in the intervention group will receive access to the IMI and can take part in up to eight intervention modules. Assessment will be conducted during the recruitment (baseline), 1-month, 2-months, and 6-month post-inclusion. Primary outcome is the mental health of the participating adolescents at 6-months post-inclusion as measured by the Youth Self Report score. Secondary self-report outcomes are mental wellbeing, self-efficacy, coping strategies and negative effects as well as mental health of the adolescents as reported by their parent(s). Included moderators are sociodemographic characteristics, working alliance, social support and the mental health diagnoses of the parents. Statistical analyses will be conducted on the intention-to-treat principle as well as with additional per-protocol analyses. Additionally, the cost-effectiveness as well as qualitative data concerning the adherence, acceptance, and feasibility of the IMI will be analyzed.DiscussionThe iCHIMPS cRCT examines the clinical- as well as cost-effectiveness of the iCHIMPS mental health promotion IMI for children of parents with mental disorders. This provides the opportunity to gain insights into an innovative as well as time- and location-independent form of support for this often-overlooked at-risk group. Additionally, the larger CHIMPS-NET project allows comparisons between internet-based and face-to-face interventions for a similar target group.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: DRKS00025158.
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Affiliation(s)
- Patrick Dülsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
- *Correspondence: Patrick Dülsen
| | - Katja Barck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anne Daubmann
- Department of Medical Biometry, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Department of Medical Biometry, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hanover, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, BKH Günzburg, Ulm University, Ulm, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Wickersham A, Ford T, Stewart R, Downs J. Estimating the impact of child and early adolescent depression on subsequent educational attainment: secondary analysis of an existing data linkage. Epidemiol Psychiatr Sci 2021; 30:e76. [PMID: 35502824 PMCID: PMC8679834 DOI: 10.1017/s2045796021000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 01/13/2023] Open
Abstract
AIMS Depression is thought to be associated with lower subsequent educational attainment during school. But, without longitudinal studies which take account of prior attainment and other potential confounders, estimates of the impact of clinically recognised depression in childhood and early adolescence are unknown. We investigated whether a clinical diagnosis of depression is associated with lower subsequent educational attainment, and whether the association is modified by gender, ethnicity and socioeconomic status. METHODS We conducted a secondary analysis of an existing administrative data linkage between national educational data and a large mental healthcare provider in London, UK (2007-2013). Depression diagnosis before age 15 (exposure) was measured from electronic health records, and subsequent educational attainment at age 15-16 (outcome) was measured from educational records. We fitted logistic regression models and adjusted for gender, ethnicity, socioeconomic status, relative age in school year, neurodevelopmental disorder diagnosis and prior attainment. We investigated effect modifiers using interaction terms. RESULTS In total, n = 63 623 were included in analysis, of whom n = 242 had record of a depression diagnosis before age 15. Depression was associated with lower odds of subsequently achieving expected attainment levels in national exams, after adjustment for all covariates (odds ratio = 0.60, 95% confidence interval = 0.43 to 0.84, p = 0.003). There was no evidence that gender, ethnicity or socioeconomic status modified this association. CONCLUSIONS These findings support a relationship between depression and lower subsequent educational attainment. This highlights the need for tailored educational interventions to support children and adolescents with depression, particularly in the lead up to key educational milestones.
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Affiliation(s)
- A. Wickersham
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R. Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Downs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Nimarko AF, Fischer AS, Hagan KE, Gorelik AJ, Lu Y, Young CJ, Singh MK. Neural Correlates of Positive Emotion Processing That Distinguish Healthy Youths at Familial Risk for Bipolar Versus Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:887-901. [PMID: 32738282 PMCID: PMC7855111 DOI: 10.1016/j.jaac.2020.07.890] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/17/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Familial risk for bipolar disorder (BD) or major depressive disorder (MDD) may lead to differential emotion processing signatures, resulting in unique neural vulnerability. METHOD Healthy offspring of a parent with BD (n = 29, "BD-risk") or MDD (n = 44, "MDD-risk") and healthy control youths without any personal or family psychopathology (n = 28, "HC") aged 8 to 17 years (13.64 ± 2.59 years) completed an implicit emotion-perception functional magnetic resonance imaging task. Whole-brain voxelwise and psychophysiological interaction analyses examined neural differences in activation and connectivity during emotion processing. Regression modeling tested for neural associations with behavioral strengths and difficulties and conversion to psychopathology at follow-up (3.71 ± 1.91 years). RESULTS BD-risk youth showed significantly reduced bilateral putamen activation, and decreased connectivity between the left putamen and the left ventral anterior cingulate cortex (vACC) and the right posterior cingulate cortex (PCC) during positive-valence emotion processing compared to MDD-risk and HC (Z >2.3; p <.001). Decreased left putamen-right PCC connectivity correlated with subsequent peer problems in BD-risk (β = -2.90; p <.05) and MDD-risk (β = -3.64; p < .05) groups. Decreased left (β = -0.09; p < .05) and right putamen activation (β = -0.07; p = .04) were associated with conversion to a mood or anxiety disorder in BD-risk youths. Decreased left putamen-right PCC connectivity was associated with a higher risk of conversion in BD-risk (HR = 8.28 , p < .01) and MDD-risk (HR = 2.31, p = .02) groups. CONCLUSION Reduced putamen activation and connectivity during positive emotion processing appear to distinguish BD-risk youths from MDD-risk and HC youths, and may represent a marker of vulnerability.
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Affiliation(s)
| | | | | | | | - Yvonne Lu
- Stanford University School of Medicine, California
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Bevan Jones R, Thapar A, Rice F, Mars B, Agha SS, Smith D, Merry S, Stallard P, Thapar AK, Jones I, Simpson SA. A Digital Intervention for Adolescent Depression (MoodHwb): Mixed Methods Feasibility Evaluation. JMIR Ment Health 2020; 7:e14536. [PMID: 32384053 PMCID: PMC7395255 DOI: 10.2196/14536] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/17/2019] [Accepted: 02/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Treatment and prevention guidelines highlight the key role of health information and evidence-based psychosocial interventions for adolescent depression. Digital health technologies and psychoeducational interventions have been recommended to help engage young people and to provide accurate health information, enhance self-management skills, and promote social support. However, few digital psychoeducational interventions for adolescent depression have been robustly developed and evaluated in line with research guidance. OBJECTIVE We aimed to evaluate the feasibility, acceptability, and potential impact of a theory-informed, co-designed digital intervention program, MoodHwb. METHODS We used a mixed methods (quantitative and qualitative) approach to evaluate the program and the assessment process. Adolescents with or at elevated risk of depression and their parents and carers were recruited from mental health services, school counselors and nurses, and participants from a previous study. They completed a range of questionnaires before and after the program (related to the feasibility and acceptability of the program and evaluation process, and changes in mood, knowledge, attitudes, and behavior), and their Web usage was monitored. A subsample was also interviewed. A focus group was conducted with professionals from health, education, social, and youth services and charities. Interview and focus group transcripts were analyzed using thematic analysis with NVivo 10 (QSR International Pty Ltd). RESULTS A total of 44 young people and 31 parents or carers were recruited, of which 36 (82%) young people and 21 (68%) parents or carers completed follow-up questionnaires. In all, 19 young people and 12 parents or carers were interviewed. Overall, 13 professionals from a range of disciplines participated in the focus group. The key themes from the interviews and groups related to the design features, sections and content, and integration and context of the program in the young person's life. Overall, the participants found the intervention engaging, clear, user-friendly, and comprehensive, and stated that it could be integrated into existing services. Young people found the "Self help" section and "Mood monitor" particularly helpful. The findings provided initial support for the intervention program theory, for example, depression literacy improved after using the intervention (difference in mean literacy score: 1.7, 95% CI 0.8 to 2.6; P<.001 for young people; 1.3, 95% CI 0.4 to 2.2; P=.006 for parents and carers). CONCLUSIONS Findings from this early stage evaluation suggest that MoodHwb and the assessment process were feasible and acceptable, and that the intervention has the potential to be helpful for young people, families and carers as an early intervention program in health, education, social, and youth services and charities. A randomized controlled trial is needed to further evaluate the digital program.
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Affiliation(s)
- Rhys Bevan Jones
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom.,Cwm Taf Morgannwg University Health Board, Wales, United Kingdom
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom
| | - Becky Mars
- Population Health Sciences, University of Bristol, Bristol, England, United Kingdom
| | - Sharifah Shameem Agha
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom.,Cwm Taf Morgannwg University Health Board, Wales, United Kingdom
| | - Daniel Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sally Merry
- Faculty of Medical and Health Sciences, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Paul Stallard
- Department for Health, University of Bath, Bath, England, United Kingdom
| | - Ajay K Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom.,National Centre for Mental Health, Cardiff University, Cardiff, Wales, United Kingdom
| | - Sharon A Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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Hisle-Gorman E, Susi A, Gorman GH. The Impact Of Military Parents’ Injuries On The Health And Well-Being Of Their Children. Health Aff (Millwood) 2019; 38:1358-1365. [DOI: 10.1377/hlthaff.2019.00276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Elizabeth Hisle-Gorman
- Elizabeth Hisle-Gorman is an associate professor of pediatrics at the Uniformed Services University of the Health Sciences, in Bethesda, Maryland
| | - Apryl Susi
- Apryl Susi is a pediatric clinical research associate in pediatrics, Uniformed Services University of the Health Sciences
| | - Gregory H. Gorman
- Gregory H. Gorman is an associate professor of pediatrics at the Uniformed Services University of the Health Sciences
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10
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Hafting M, Gullbrå F, Anderssen N, Rørtveit G, Smith-Sivertsen T, van Doesum K. Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse. Front Psychiatry 2019; 9:724. [PMID: 30670986 PMCID: PMC6331400 DOI: 10.3389/fpsyt.2018.00724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/07/2018] [Indexed: 12/03/2022] Open
Abstract
Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.
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Affiliation(s)
- Marit Hafting
- Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Guri Rørtveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Karin van Doesum
- Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Impluz, Prevention Team Mental Health, Deventer, Netherlands
- Regional Center of Child and Youth Mental Health and Child Welfare, Artic University of Tromsø, Tromsø, Norway
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11
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Davison J, Scott J. Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease. Early Interv Psychiatry 2018; 12:1112-1119. [PMID: 28188672 DOI: 10.1111/eip.12421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies of potential interventions for asymptomatic individuals at risk of severe mental disorders (ie, clinical stage 0) have focused on genetic counselling or the views of adults with established disease. No study has interviewed youth at risk of bipolar disorders (BD). METHODS Qualitative analysis of interviews with asymptomatic adolescent offspring of adults with BD (OSBD = 7) and unrelated parents with bipolar disorders (PBD = 6) to examine manifest and latent themes in the dialogue. RESULTS Core themes in both groups were ignorance regarding the magnitude of risk of BD onset in offspring and greater concerns for the health of other family members than for oneself. Parents expressed anxieties in coping with the uncertainty about whether their children would inherit BD and their desire to reduce this risk was partly driven by guilt and their sense of responsibility; PBD favoured the introduction of specialized clinical OSBD services. In contrast, the priority for OSBD was advice on coping with a parent with BD; OSBD favoured access to generic non-clinical peer group support, which they perceived as less stigmatizing than specialist services. CONCLUSION The study highlights that youth at risk of BD should be allowed to express their ideas on what interventions they believe are likely to be most beneficial for them, as their views may differ from other advocates who are routinely consulted, such as PBD. A noteworthy finding was that OSBD thought that being included in the clinical dialogue about their parents' BD would decrease rather than increase their stress levels.
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Affiliation(s)
- Jo Davison
- Newcastle Early Intervention in Psychosis Service, NTW NHS Trust, Newcastle, UK
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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12
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Matar JL, Maybery DJ, McLean LA, Reupert A. Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users. J Med Internet Res 2018; 20:e10158. [PMID: 30381281 PMCID: PMC6236203 DOI: 10.2196/10158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/16/2018] [Accepted: 08/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young people who have a parent with a mental illness face elevated risks to their mental health and well-being. However, they may not have access to appropriate interventions. Web-based interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. OBJECTIVE This study sought to determine the utility of a Web-based intervention to meet the needs of young people who have a parent with a mental illness and their perspectives regarding the types of features of such a website. METHODS A systematic, 2-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1, n=14; Round 2, n=268) from urban and regional settings in Australia who self-reported that their parent has a mental illness. "Regional" was used to refer to nonurban participants in the study. After ascertaining whether a Web-based intervention was warranted, Web-based intervention features were identified, including how the site might be facilitated, topics, duration and frequency, and the nature of the professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as 2-way between-groups analysis of covariance (ANCOVA) controlling for age and chi-square test of independence analysis. RESULTS Both rounds highlighted a strong preference for a Web-based intervention. Consensus was reached for a professionally monitored site, young people and professionals having equal input into the weekly facilitated sessions (eg, sharing the lead role in discussions or deciding on relevant session content), unlimited time access, 1-hour, open discussion, weekly sessions over 6 weeks, psychoeducation about mental illness, and considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for a Web-based intervention for young people who have a parent with a mental illness. However, effect sizes were small to moderate, limiting practical application. CONCLUSIONS Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, Web-based intervention, with input from professional facilitators and other young people who have a parent with a mental illness, in addition to recommendations to external resources. These findings may inform the development of future Web-based interventions for this highly vulnerable group.
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Affiliation(s)
- Jodie L Matar
- Faculty of Education, Monash University, Clayton, Australia
| | | | - Louise A McLean
- Education, Psychology Programs, Monash University, Clayton, Australia
| | - Andrea Reupert
- Education, Psychology Programs, Monash University, Clayton, Australia
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13
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Ache AL, Moretti PF, Rocha GP, Recondo R, Pacheco MA, Spanemberg L. Psychopathology and impairment of quality of life in offspring of psychiatric inpatients in southern Brazil: a preliminary study. Child Adolesc Psychiatry Ment Health 2018; 12:45. [PMID: 30377443 PMCID: PMC6196021 DOI: 10.1186/s13034-018-0251-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 10/12/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the quality of life and risk of psychopathology in the infant and adolescent offspring of psychiatric inpatients from a general hospital unit. METHODS Offspring (4-17 years old) of psychiatric inpatients were interviewed face-to-face and assessed with the Strengths and Difficulties Questionnaire (SDQ). Interviews with caregivers and the hospitalized parents were also performed. The quality of life of the offspring, psychopathology of their hospitalized parents, and their current caregivers were investigated in order to evaluate any associations between these aspects and psychopathology in the offspring. RESULTS Thirty-four children of 25 patients were evaluated, 38.2% of which presented high risk for some type of psychopathology including hyperactivity or attention deficit disorder (38.2%), behavioral disorders (20.6%), and emotional disorders (17.6%). While only the minority of these children (17.6%) were already receiving mental health treatment, another 41.2% of them exhibited some degree of symptoms and were only referred for specialized assessment. Additionally, 61.8% of the children were reported to be suffering from some impairment in their quality of life. CONCLUSION This preliminary study found a high rate of psychopathology in children of psychiatric inpatients. These results corroborate previous evidence that children and adolescents with parents with severe psychopathology are at high risk for developing mental disorders. Public policies and standard protocols of action directed to this population are urgently needed, especially for offspring of parents that are hospitalized in psychiatric in-patient units of general hospitals.
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Affiliation(s)
- Ana Luiza Ache
- Núcleo de Formação em Neurosciências da Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, CEP 90619-900 Brazil
| | - Paula Fernandes Moretti
- 0000 0001 2198 7041grid.411379.9Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, 6º andar sul, Porto Alegre, CEP 90619-900 Brazil
| | - Gibsi Possapp Rocha
- Núcleo de Formação em Neurosciências da Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, CEP 90619-900 Brazil
| | - Rogéria Recondo
- 0000 0001 2198 7041grid.411379.9Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, 6º andar sul, Porto Alegre, CEP 90619-900 Brazil
| | - Marco Antônio Pacheco
- Núcleo de Formação em Neurosciências da Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, CEP 90619-900 Brazil ,0000 0001 2198 7041grid.411379.9Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, 6º andar sul, Porto Alegre, CEP 90619-900 Brazil
| | - Lucas Spanemberg
- Núcleo de Formação em Neurosciências da Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, CEP 90619-900 Brazil ,0000 0001 2198 7041grid.411379.9Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, 6º andar sul, Porto Alegre, CEP 90619-900 Brazil
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Wahl P, Bruland D, Bauer U, Okan O, Lenz A. What are the family needs when a parent has mental health problems? Evidence from a systematic literature review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:54-66. [DOI: 10.1111/jcap.12171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Patricia Wahl
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
| | - Dirk Bruland
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Ullrich Bauer
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Orkan Okan
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Albert Lenz
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
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15
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Thapar AK, Hood K, Collishaw S, Hammerton G, Mars B, Sellers R, Potter R, Craddock N, Thapar A, Rice F. Identifying key parent-reported symptoms for detecting depression in high risk adolescents. Psychiatry Res 2016; 242:210-217. [PMID: 27288739 DOI: 10.1016/j.psychres.2016.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/27/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022]
Abstract
Adolescent offspring of depressed parents are at particularly heightened risk of developing early onset Major Depressive Disorder (MDD) yet are unlikely to access services. We therefore aimed to identify a parsimonious combination of parent-reported symptoms that accurately detected offspring MDD. We used a multi-sample study comprising a development sample of 335 offspring of adults with recurrent MDD assessed on three occasions (mean age 12.4-14.8 years) and an independent validation sub-sample of 807 adolescents from a general population cohort (mean age 13.1 years). Parent ratings of psychiatric symptoms in adolescent offspring were assessed using established questionnaires. The best performing four-item combination of symptoms was identified. Accuracy in detecting concurrent DSM-IV MDD diagnosis, assessed by direct adolescent and parent interviews, was compared to the well-established 13-item short Moods and Feelings Questionnaire (sMFQ) using ROC curve analysis. The combination identified (concentration problems, anhedonia, worrying excessively and feeling unloved) performed equivalently to the sMFQ both in the development dataset and in the validation dataset. We concluded that a combination of four parent-reported mental health items performs equivalently to an established, longer depression questionnaire measure in detecting a diagnosis of adolescent major depressive disorder among offspring of parents with recurrent MDD and needs further evaluation.
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Affiliation(s)
- Ajay K Thapar
- Taff Riverside Practice, Wellington Street, Cardiff CF11 9SH, Wales, UK; Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Kerenza Hood
- Cardiff Centre for Trials Research, Neuadd Merionnydd, University Hospital of Wales, Cardiff University, Cardiff CF14 4XN, Wales, UK
| | - Stephan Collishaw
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Gemma Hammerton
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Becky Mars
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, England, UK
| | - Ruth Sellers
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Robert Potter
- Child and Adolescent Mental Health Services, Trehafod, Waunarlwydd Road, Swansea SA2 0GB, Wales, UK
| | - Nick Craddock
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Anita Thapar
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK
| | - Frances Rice
- Institute of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HX, Wales, UK; Division of Psychology and Language Sciences, University College, Bedford Way, London WC1H 0AP, England, UK
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16
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Using neuroimaging to evaluate and guide pharmacological and psychotherapeutic treatments for mood disorders in children. CNS Spectr 2015; 20:359-68. [PMID: 25659836 DOI: 10.1017/s1092852914000819] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mood disorders are increasing in childhood, and often require multimodal and comprehensive treatment plans to address a complex array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for treatment and stabilization. Current evidence supports the use of a number of interventions in children and adolescents diagnosed with DSM-5 mood spectrum disorders, which are associated with impairments in prefrontal-striatal-limbic networks, which are key for emotional functioning and regulation. Yet, little is known about the neurobiological effects of interventions on the developing brain. This chapter provides a synopsis of the literature demonstrating the neural effects of psychotropic medications and psychotherapy in youth with depressive or bipolar spectrum disorders. Additional longitudinal and biological studies are warranted to characterize the effects of these interventions on all phases and stages of mood illness development in children and adolescents.
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17
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Hammerton G, Mahedy L, Mars B, Harold GT, Thapar A, Zammit S, Collishaw S. Association between Maternal Depression Symptoms across the First Eleven Years of Their Child's Life and Subsequent Offspring Suicidal Ideation. PLoS One 2015; 10:e0131885. [PMID: 26151929 PMCID: PMC4495034 DOI: 10.1371/journal.pone.0131885] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
Depression is common, especially in women of child-bearing age; prevalence estimates for this group range from 8% to 12%, and there is robust evidence that maternal depression is associated with mental health problems in offspring. Suicidal behaviour is a growing concern amongst young people and those exposed to maternal depression are likely to be especially at high risk. The aim of this study was to utilise a large, prospective population cohort to examine the relationship between depression symptom trajectories in mothers over the first eleven years of their child’s life and subsequent adolescent suicidal ideation. An additional aim was to test if associations were explained by maternal suicide attempt and offspring depressive disorder. Data were utilised from a population-based birth cohort: the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed repeatedly from pregnancy to child age 11 years. Offspring suicidal ideation was assessed at age 16 years. Using multiple imputation, data for 10,559 families were analysed. Using latent class growth analysis, five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). The prevalence of past-year suicidal ideation at age 16 years was 15% (95% CI: 14-17%). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19, 4.21)], with evidence for smaller increases in risk of suicidal ideation in offspring of mothers with sub-threshold, increasing and mild symptoms. These associations were not fully accounted for by maternal suicide attempt or offspring depression diagnosis. Twenty-six percent of non-depressed offspring of mothers with chronic-severe depression symptoms reported suicidal ideation. Risk for suicidal ideation should be considered in young people whose mothers have a history of sustained high levels of depression symptoms, even when the offspring themselves do not have a depression diagnosis.
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Affiliation(s)
- Gemma Hammerton
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Liam Mahedy
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Becky Mars
- Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
| | - Gordon T. Harold
- Andrew and Virginia Rudd Centre for Adoption Research and Practice, School of Psychology, University of Sussex, Sussex, United Kingdom
- International Center for Research in Human Development, Tomsk State University, Tomsk, Tomsk Oblast, Russia
| | - Anita Thapar
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Stanley Zammit
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
| | - Stephan Collishaw
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
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18
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Collishaw S. Annual research review: Secular trends in child and adolescent mental health. J Child Psychol Psychiatry 2015; 56:370-93. [PMID: 25496340 DOI: 10.1111/jcpp.12372] [Citation(s) in RCA: 403] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health. SCOPE AND METHODOLOGY This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database). FINDINGS Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.
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Affiliation(s)
- Stephan Collishaw
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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20
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Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry 2014; 36:296-301. [PMID: 24417955 PMCID: PMC4517666 DOI: 10.1016/j.genhosppsych.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate determinants of mental health service use among depressed adolescents. METHOD We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use. RESULTS Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77-16.35), parental history of depression/anxiety (OR 4.12, CI 1.36-12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use. CONCLUSION Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.
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Affiliation(s)
- David J. Breland
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Elizabeth McCauley
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Carol Rockhill
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences; UW School of Medicine
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
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A Direct Method of Assessing Underlying Cognitive Risk for Adolescent Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1279-88. [DOI: 10.1007/s10802-013-9760-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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