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Park JL, Clark CA, Bagshawe M, Kuntz J, Andrea-Perri, Avril-Deegan, Marriott B, Rahman A, Susan-Graham, McMorris CA. A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic. J Can Acad Child Adolesc Psychiatry 2024; 33:3-17. [PMID: 38449720 PMCID: PMC10914150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/10/2023] [Indexed: 03/08/2024]
Abstract
Background The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic. Objectives This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic. Method This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS). Results The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers. Conclusions There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.
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Affiliation(s)
- Joanne L Park
- Department of Psychology, University of Calgary, Calgary, Alberta
- Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Chris A Clark
- Werklund School of Education, University of Calgary, Calgary, Alberta
| | - Mercedes Bagshawe
- Werklund School of Education, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Jennifer Kuntz
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Andrea-Perri
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Avril-Deegan
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Brian Marriott
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Abdul Rahman
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Susan-Graham
- Department of Psychology, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta
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Wu M, Joubran E, Kumar D, Assadi ND, Nguyen H. Variations in Anxiety and Related Psychiatric Comorbidity Levels Among Youths With Individual Diagnoses of Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder and Those With Both Diagnoses. Cureus 2023; 15:e41759. [PMID: 37575727 PMCID: PMC10416267 DOI: 10.7759/cureus.41759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) individually and those with co-occurring ADHD and ASD experience higher rates of total anxiety and psychiatric comorbidities such as gender dysphoria and locomotor skills compared to their typically developing (TD) peers. In this study, it was hypothesized that youth with comorbid ADHD and ASD would experience higher levels of overall anxiety, specifically separation, generalized, and social anxiety. A literature review of relevant studies published from 2007 to 2020 was performed, with a search involving key terms such as "Anxiety," "ADHD" and "ASD'". It was discovered that individuals with ADHD or ASD had higher levels of anxiety compared to their peers. Furthermore, children who have co-occurring ADHD and ASD had more serve levels of anxiety than children with an individual diagnosis of ADHD or ASD. Children with ASD, ADHD, and co-occurring ADHD and ASD had a higher prevalence of gender dysphoria and impaired locomotor skills, which lead to higher levels of psychiatric comorbidities seen in this population. It can be hypothesized psychiatric comorbidities could also have implications for the high anxiety levels seen in this population but further research is needed to confirm this.
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Affiliation(s)
- Michael Wu
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Ernesto Joubran
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Divya Kumar
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Nasser D Assadi
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Hoang Nguyen
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Hotez E, Rava JA, Shea L, Kuo A. Developing "Adulting for Health": Investigating the Health Needs of Neurodivergent Emerging Adults. Cureus 2023; 15:e41102. [PMID: 37519609 PMCID: PMC10375927 DOI: 10.7759/cureus.41102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Neurodivergent emerging adults - defined as individuals between the ages of 18 and 30 with intellectual and/or developmental disabilities (e.g., attention-deficit hyperactivity disorder (ADHD), autism, cerebral palsy, learning disabilities, seizures, developmental delays, with or without intellectual impairment) and physical and/or sensory disabilities (e.g., blindness or hearing impairment) - experience poor mental and physical health outcomes. Existing interventions are insufficient because they are not based on the self-reported and developmental needs of this population. METHODS The current study is an exploratory pilot study that features a multidimensional health-based needs assessment of self-identified neurodivergent emerging adults with ADHD, learning disabilities, autism, and other conditions, mean (M) age = 22.8; standard deviation (SD) = 3.4; n = 26). This research used validated measures. The assessment - administered via Qualtrics to the participants in two sites - included the Mental Health Continuum-Short Form, Kessler-6 Psychological Distress Scale, Project EAT (Eating and Activity over Time)-IV (with the intuitive eating, weight-related control, emotional eating, and physical activity subscales), and an original health-focused needs assessment developed by interdisciplinary healthcare professionals and neurodivergent individuals. RESULTS The sample reported low positive mental health, with only 3% reportedly "flourishing." The sample also reported high psychological distress according to clinical and psychometric cut-off scores; varied intuitive eating and weight-control behaviors and attitudes; and distinct needs related to integrating the principles of health promotion into daily life, navigating the healthcare system, and learning from healthcare professionals. Based on these findings, we present an initial conceptualization of "Adulting for Health," a potential virtual education program to promote health-related knowledge and capacities for this population. CONCLUSIONS The results from this exploratory pilot study can be incorporated into existing programs and spur efforts to develop and test new interventions that can ameliorate health disparities for neurodivergent emerging adults.
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Affiliation(s)
- Emily Hotez
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Julianna A Rava
- Public Health, University of California Los Angeles Fielding School of Public Health, Los Angeles, USA
| | - Lindsay Shea
- Health Policy, Drexel University AJ Drexel Autism Institute, Philadelphia, USA
| | - Alice Kuo
- Division of Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Sejdiu A, Basith SA, Ayala V, Maheshwari S. The Emergence of New-Onset Obsessive and Compulsive Disorder in an Adolescent During COVID-19 Pandemic. Cureus 2021; 13:e17907. [PMID: 34660102 PMCID: PMC8509108 DOI: 10.7759/cureus.17907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has had a huge toll on both the physical and mental health of people around the globe. Neuropsychiatric symptoms, as well as long-term sequelae, have been demonstrated in those afflicted with COVID-19. These symptoms range from cognitive, attention deficit, new-onset anxiety, depression, psychosis, seizures, and post-traumatic stress. Prolonged lockdown led to social isolation which negatively affected the mental well-being of many individuals. This particularly caused a relapse of psychiatric symptoms due to stress related to the COVID-19 pandemic. It sparked an increase in hoarding behaviors such as obtaining germicidal and cleaning supplies. In this report, we present a case of an adolescent male presenting with a new onset of obsessive-compulsive disorder with symptoms similar to olfactory hallucinations and olfactory reference syndrome in the setting of the COVID-19 pandemic.
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Affiliation(s)
| | - Sayeda A Basith
- Psychiatry and Behavioral Sciences, Medical University of the Americas, Charlestown, KNA
| | - Victoria Ayala
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
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Abstract
Globally, the prevalence of chronic, non-communicable diseases is increasing at an alarming rate. Amongst it, Type 2 diabetes mellitus (DM) is becoming more prevalent among young individuals due to obesity and sedentary habits. With the advent of COVID-19, there has been an increasing trend for diabetes and its complications. Here we describe a 13-year-old female girl with polyuria, polydipsia for two months with further assessment leading to a diagnosis of Type 2 DM who is now closely monitored by a pediatric endocrinologist. She remains euglycemic with insulin and lifestyle changes. Early-onset DM is complex and requires multidisciplinary care for preventing complications and comorbidities. Hence, early recognition and management are crucial.
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Affiliation(s)
- Angel Sunny
- Department of Pediatrics, Jagadguru Sri Shivarathreeshwara Hospital, Mysuru, IND
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Graaf G, Accomazzo S, Matthews K, Mendenhall A, Grube W. Evidence Based Practice in Systems of Care for Children with Complex Mental Health Needs. J Evid Based Soc Work (2019) 2021; 18:394-412. [PMID: 33827388 DOI: 10.1080/26408066.2021.1891172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Community-based social work with families and youth with complex behavioral health needs highlights challenges to incorporating empirical evidence into routine practice. This article presents a framework for integrating evidence in community-based Systems of Care for these children and their families.Method: This article reviews research on various approaches to integrating evidence into children's behavioral health and community-based care and contextualizes it within dominant paradigms of Systems of Care (SoC) and Wraparound principles.Results: Based on this review, this article proposes the Evidence-Based Practice in Systems of Care (EBP in SoC) model. The model describes how to incorporate evidence into every aspect of community-based SoCs for children with mental health concerns.Discussion and Conclusion: Discussion of the model will focus on implications of using the framework for practitioners, mental health organizations, communities, and state and federal administration and policymaking.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Sarah Accomazzo
- School of Social Welfare, University of Kansas, Lawrence, USA
| | - Kris Matthews
- School of Social Welfare, University of Kansas, Lawrence, USA
| | - Amy Mendenhall
- School of Social Welfare, University of Kansas, Lawrence, USA
| | - Whitney Grube
- School of Social Welfare, University of Kansas, Lawrence, USA
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Kennedy H, Montreuil TC. The Late Positive Potential as a Reliable Neural Marker of Cognitive Reappraisal in Children and Youth: A Brief Review of the Research Literature. Front Psychol 2021; 11:608522. [PMID: 33679497 PMCID: PMC7925879 DOI: 10.3389/fpsyg.2020.608522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
The mental health of young people is a growing public health concern. With socio-emotional difficulties in youth often resulting in psychiatric disorders later in life and most with mental health conditions rather stabilizing in time, it is essential to support healthy socio-emotional development. With a comprehensive definition of mental health, since emotion regulation (ER) plays a critical role in prevention, it becomes imperative to better understand how children effectively manage their emotions from an early age. Determining effective use of ER skills relies on adequate measurements. Typical methods of data collection in children present consistent shortcomings. This review addresses research findings considering the suitability of the late positive potential measured through electroencephalogram as a neural indicator of ER in children and youth. There is growing evidence, as reported in this review, that indicates that the late positive potential may be a reliable neural indicator of children's cognitive reappraisal abilities more specifically. Results generally suggest that the late positive potential amplitudes are sensitive to directed reappraisal in children. However, given the scant research, questions remain regarding developmental trends, methodology, interindividual variability, reappraisal of various stimuli, and how the late positive potential may relate to more traditional measures of ER. Directions for future research are provided, which are expected to address unanswered research questions and fill literature gaps. Taken together, the findings reviewed indicate that the late positive potential is generally sensitive to directed cognitive reappraisal in children and that there is promise of establishing this neural marker as an indicator of ER.
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Affiliation(s)
- Heather Kennedy
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Tina C Montreuil
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Research Institute, Montreal University Health Centre, Montreal, QC, Canada
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Pignatiello A, Stasiulis E, Solimine C, Ayad O, Boydell KM. Lessons Learned in a Physician Referral to Pediatric Telemental Health Services Program. J Can Acad Child Adolesc Psychiatry 2019; 28:99-104. [PMID: 31798648 PMCID: PMC6863575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study explores the physician referral and engagement process of a pediatric telemental health program based in a large urban teaching children's hospital, and identifies the processes, strengths and challenges from the perspectives of Primary Care Physicians (PCPs) and telepsychiatrist consultants. METHODS A mixed methods approach was used. This included an online survey completed by 43 PCPs in Ontario rural communities who had referred patients to the telemental health program. Qualitative interviews were conducted with 11 child/adolescent telepsychiatrists who provide consultations via teleconferencing. RESULTS The majority of PCPs (61%) reported somewhat to moderate satisfaction with referral experiences. Challenges identified by physicians were related to communication and administration issues including: lack of timely follow-up appointments and continuity of care; lengthy referral forms; and recommendations for mental health services not accessible in their communities. Similarly, psychiatrist consultants expressed frustration with the sparse information they received from referring physicians and most significantly, the absence of appropriate service providers/professionals during the consultation to provide collateral information and ensure uptake of recommendations. CONCLUSION Telemental health programs provide a valuable service to PCPs and their child and youth clients that could be significantly enhanced with a different consultation model. Such models of service delivery require protocols to educate PCPs, improve communication and information sharing and establish clear expectations between PCPs and telepsychiatry consultants.
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Affiliation(s)
- Antonio Pignatiello
- Associate Psychiatrist-in-Chief; Medical Director, TeleLink Mental Health Program, The Hospital for Sick Children; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Associate Dean, Health Professions Student Affairs, MD Program, University of Toronto, Toronto, Ontario
| | - Elaine Stasiulis
- Research Fellow, Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, Ontario
| | - Carmela Solimine
- Research Manager (at time of writing), Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Omar Ayad
- Project Manager, TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario
| | - Katherine M Boydell
- Professor of Mental Health, Black Dog Institute, University of New South Wales, New South Wales, Australia
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