Prevalence of Mental Health Diagnoses Among Early Adolescents Before and During Foster Care

Receipt and Timeliness of Mental Health Assessment, Treatment, and Acute Services Following Foster Care Entry

Children often enter foster care (FC) with mental health (MH) concerns. Failure or delay in initiating treatment may result in overreliance on acute MH services. This report leverages 2010-2019 linked administrative child welfare and healthcare claims data for 13,562 Wisconsin children entering FC at ages 3-16 years to describe patterns of MH services during FC and examine how MH service use varies by demographic characteristics and maltreatment, FC, and MH histories. Two-thirds of children received MH assessment or treatment during FC, of whom 61% initiated services within 3 months of entry. Younger age, kinship care, and absence of MH history were negatively associated with onset of assessment and treatment. One in 7 children used acute MH services, with higher rates for Black children, adolescents, and youth in non-family settings. Timely MH assessment and treatment is important for foster children's wellbeing, but current guidelines may lack accountability and monitoring mechanisms.

Association of adolescent obesity with Anxiety, Depression and Attention-Deficit/Hyperactivity disorder in the Arab population in Israel - a nationwide study

BACKGROUND

The health ramifications of adolescent obesity are understudied in the Israeli Arab population, and the impact of ethnicity on the association of obesity with mental health problems is unclear.

AIM

To examine the association of weight categories with Anxiety, Depression and Attention-Deficit/Hyperactivity Disorder (ADHD) among Arab adolescents in Israel and to compare this association to a Jewish comparison group.

METHODS

A cross-sectional nationwide study of 313,936 Arab adolescents aged 14-19 years between the years 2007-2022, and 289,616 Jewish adolescents in a comparison group.

RESULTS

The aORs for Anxiety, Depression and ADHD in Arab adolescents increased from a reference 'normal weight' category to 'class 3 obesity', reaching aORs (95 % CI) of 1.31 (1.16-1.47), 1.64 (1.31-2.02) and 1.51 (1.40-1.63) in 'class 2 obesity', and 1.51 (1.20-1.87), 2.81(2.00-3.84) and 1.69 (1.45-1.96) in 'class 3 obesity', respectively. The dose-dependent association between weight categories and psychiatric comorbidity was confirmed in sensitivity analyses with comorbidity with the purchase of medications serving as the dependent variable. The Jewish comparison group demonstrated a comparable increment in aORs with increase in weight category. The association between excessive weight categories and psychiatric comorbidities was stronger in Arab females, than in males.

LIMITATIONS

Relying on the recorded weight and height measurements and the diagnoses of psychiatric comorbidity could lead to bias.

CONCLUSION

The study findings emphasize the need to relate to the mental health of adolescents with excessive weight, which can improve their overall quality of life and the success of adolescent weight loss intervention programs.

Mental disorder diagnoses and symptoms and functional impairment in school-age children in the care of child protective services

BACKGROUND

About 50 % of children in the care of child protective services present at least one mental disorder, but few studies have looked at whether there are differences in mental disorders or symptoms between children placed in out-of-home care (foster care and residential care) and their community peers.

OBJECTIVE

This study documents the mental disorder diagnoses and symptoms among children in out-of-home care and their associations with children functional impairment. It also compares out-of-home care children with those from the community.

PARTICIPANTS AND SETTING

The sample was composed of children aged 5 to 12 years in foster care (n = 154), in residential care (n = 111), and from the community (n = 92).

METHODS

Caregivers reported the children's diagnoses and completed questionnaires on the children's symptoms.

RESULTS

1) Proportionally more children in out-of-home care presented a mental disorder than did children from the community. Proportions were similar for those in foster care and those in residential care; 2) Children in out-of-home care presented more symptoms than those from the community for all the mental disorders considered and the children in residential care presented more symptoms than did those in foster care for about half of the disorders considered; 3) symptoms were strongly associated with functional impairment; and 4) the symptoms of RAD, ADHD, OCD, CD, and ODD proved significant predictors of functional impairment.

CONCLUSIONS

This study provides a picture of the mental disorders and symptoms among samples of school-age children in the care of child protective services and raises questions about the proportions of some of the diagnosis that children receive.

ADHD in Black Youth: A Content Analysis of Empirical Research from 1972 to 2023

OBJECTIVE

The purpose of this content analysis study was to characterize patterns of research on Black youth with ADHD.

METHOD

Relevant articles were identified through searching psychology and medical databases and cross-referencing citations in previously published review articles. The 204 empirical articles included in this study (1) were conducted in the United States, (2) had a predominantly child or adolescent sample, (3) had more than 80% Black youth/families in the study sample and/or conducted separate analyses for Black youth/families, and (4) examined ADHD symptoms or diagnoses. Articles were categorized into five primary content areas: Assessment, Treatment, Perceptions, Prevalence, and Associated Correlates. Journal characteristics, sample characteristics, and methodological characteristics are presented across these content areas.

RESULTS

Findings show a relatively low representation of Black youth with ADHD in the literature, with most studies using race comparative approaches and secondary data analyses, and many being published in medical journals.

CONCLUSION

Based on these results, changes are recommended both at the individual study and broader systems levels (e.g., funding agencies). More research, funding, and publications centering Black youth with ADHD are vital to understanding and correcting long-standing health disparities for this community.

The Impact of Health Status on Health Care Utilization of Children in Foster Care

OBJECTIVES

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

METHODS

To estimate relationships between health status and health care utilization, this study used electronic health records from 4976 children in foster care seen at a children's hospital in the southwestern United States, 2017 to 2020. An algorithm classified patients' health status as nonchronic, noncomplex chronic, or complex chronic. Descriptive statistics were used to describe patients and utilization. The χ 2 , Kruskal-Wallis, and pairwise comparison post hoc tests were used to examine relationships between health status and health care utilization. Zero-inflated negative binomial (ZINB) regression further estimated relationships between health status and health care utilization while factoring in demographic and placement characteristics.

RESULTS

Within the sample, 35.6% had complex chronic health status. Significant differences were found among health status groups in age, gender, ethnicity, and maltreatment exposure. Both nonparametric pairwise comparisons and the ZINB regression model showed that having complex chronic health was associated with higher utilization of all hospital resources: emergency, admission, primary and specialty care, and various therapies, relative to having noncomplex chronic and nonchronic health.

CONCLUSION

A high percentage of children in foster care had complex chronic health, and these patients used significantly more resources. This study suggests that hospital-based health clinics focused on children in foster care and care coordination may be warranted.

Re-Imagining Child Welfare to Support Children and Families

Children and adolescents in foster care include many of the most severely traumatized victims of child abuse and neglect. They deserve the best possible care and treatment, yet their outcomes remain poor. The persistence of poor outcomes for youth in foster care reflects challenges of psychiatric diagnostic formulation and of service system design/access, both areas in which child and adolescent psychiatrists have a key role to improve care and outcomes.

Trends and Prevalence of Psychotropic Medication Use in Children and Adolescents in the Period Between 2013 and 2023: A Systematic Review

Mental health problems among children and adolescents are a significant global public health concern, with a prevalence of approximately 10-20%. Psychotropic medications, including stimulants, antipsychotics, antidepressants, and mood stabilizers, have been proven effective in treating various psychiatric disorders among children and adolescents. Despite the common use of these medications, they have various side effects and complications. This systematic review aimed to assess the trends and prevalence of psychotropic medication use among children and adolescents from 2013 to 2023. A comprehensive literature search was conducted in PubMed, Web of Science, Ovid, Scopus, and Cochrane databases using relevant keywords. Two independent researchers screened the studies for inclusion and exclusion criteria. Data were extracted using a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA), including information on study characteristics, participant demographics, psychiatric disorders, and psychotropic medications. The risk of bias assessment was performed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool for non-randomized studies of interventions (NRSI) and Risk of Bias 2 (ROB2) for the randomized clinical trial. Data synthesis was conducted through a qualitative interpretation of the findings. A total of 52 papers were identified through the search, with 37 remaining after duplicate removal. After applying the inclusion and exclusion criteria, nine articles were considered suitable for the systematic review. A total of 9,034,109 patients suffered from several psychiatric diseases, such as autism, major depressive disorder, Down syndrome, attention-deficit/hyperactivity disorder, adjustment disorder, anxiety, bipolar disorder, conduct disorder, depression, personality disorder, psychotic disorder, tic disorder, pervasive developmental disorder, and disruptive behavior disorder. Stimulants showed a consistent prevalence rate over the years. Antidepressants, including selective serotonin reuptake inhibitors, have demonstrated variations over the years, with a substantial increase in 2015, followed by a decrease in subsequent years. In addition, antipsychotics, including atypical antipsychotics, have varied over the years; however, their use increased in 2023. Anticonvulsants and anxiolytics were also utilized, albeit at lower prevalence rates. This systematic review provides an overview of the trends and prevalence of psychotropic medication use among children and adolescents from 2013 to 2023. The prevalence of antipsychotic prescribing has shown fluctuations among different countries over the years, with a decline in recent years but a slight increase in 2023. Further research is warranted to explore the factors influencing these trends and to assess the long-term effectiveness and safety of psychotropic medications in children and adolescents.