[Cohort studies in child and adolescent psychiatry]

[Structured Assessment of Mental Health Issues in Preventive Health Examinations - Findings from the Cluster-Randomized PSYCH-U Study]

BACKGROUND

Early detection of psychological problems is crucial to prevent chronic progression. The Psych-U study evaluated the added value of structured assessment of psychological issues during U-screenings compared to routine screenings without such assessment.

METHODS

In a cluster-randomized controlled design, a two-arm intervention group (IG; Strengths and Difficulties Questionnaire, SDQ, and Mannheimer Elternfragebogen, MEF) was compared to a control group (CG). In the IG, parents completed a tablet-based structured assessment of potential psychological issues before the U-screening, which was then discussed with pediatricians during the screening. Outcomes included acceptance (participation rate; parent phone interviews), feasibility (focus groups with practice teams), and effectiveness (referral rates) of the structured assessment versus routine care.

RESULTS

A total of N=3,138 families participated (participation rate: 85.3%). In parent phone interviews (n=348), the SDQ and MEF showed high acceptance. Focus group interviews with practice teams indicated high feasibility, but noted that implementing structured assessment into routine care would require systemic changes at the health system level (e.g., reimbursement for extra effort), practice level (e.g., digital data collection), and patient level (e.g., addressing language barriers). The IG had a higher referral rate than the CG.

CONCLUSION

Structured assessment of psychological issues appears beneficial but requires structural adjustments. Additionally, sufficient local referral options should be available.

Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany

The coronavirus pandemic and related restrictions impacted the daily lives of children and youth, partly due to the closure of schools and the absence of outdoor activities. The aim of this study was to investigate, quantify, and critically discuss the effect of the pandemic and related restrictions on consultations pertaining to depression and anxiety disorders in children and adolescents. This retrospective cross-sectional study was based on medical record data from the Disease Analyzer database (IQVIA) and included all children and adolescents aged 2-17 years with at least one visit to one of 168 German pediatric practices between April 2019 and December 2019 (n = 454,741) or between April 2020 and December 2020 (n = 417,979). The number of children and adolescents with depression and anxiety disorder diagnoses per practice and the prevalence of these diagnoses were compared for April 2020-December 2020 versus April 2019-December 2019. The number of children and adolescents with depression and anxiety diagnoses per practice increased in April 2020-December 2020 compared to the same period in 2019 (anxiety: + 9%, depression: + 12%). The increase was much greater in girls than in boys (anxiety: + 13% vs. + 5%; depression + 19% vs. + 1%). The prevalence of anxiety disorder increased from 0.31 to 0.59% (p < 0.001), and that of depression from 0.23 to 0.47% (p < 0.001). The biggest increases were observed for girls (anxiety from 0.35 to 0.72% (+ 106%, p < 0.001), depression from 0.28 to 0.72% (+ 132%, p < 0.001). This study shows an increase in the number of pediatric diagnoses of depression and anxiety disorders in the pandemic year 2020 compared to the previous year.

Prediction Along a Developmental Perspective in Psychiatry: How Far Might We Go?

Most mental disorders originate in childhood, and once symptoms present, a variety of psychosocial and cognitive maladjustments may arise. Although early childhood problems are generally associated with later mental health impairments and psychopathology, pluripotent transdiagnostic trajectories may manifest. Possible predictors range from behavioral and neurobiological mechanisms, genetic predispositions, environmental and social factors, and psychopathological comorbidity. They may manifest in altered neurodevelopmental trajectories and need to be validated capitalizing on large-scale multi-modal epidemiological longitudinal cohorts. Moreover, clinical and etiological variability between patients with the same disorders represents a major obstacle to develop effective treatments. Hence, in order to achieve stratification of patient samples opening the avenue of adapting and optimizing treatment for the individual, there is a need to integrate data from multi-dimensionally phenotyped clinical cohorts and cross-validate them with epidemiological cohort data. In the present review, we discuss these aspects in the context of externalizing and internalizing disorders summarizing the current state of knowledge, obstacles, and pitfalls. Although a large number of studies have already increased our understanding on neuropsychobiological mechanisms of mental disorders, it became also clear that this knowledge might only be the tip of the Eisberg and that a large proportion still remains unknown. We discuss prediction strategies and how the integration of different factors and methods may provide useful contributions to research and at the same time may inform prevention and intervention.