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Majidi S, Cohen L, Holt RIG, Clements M, O’Neill S, Renard E, Tynan D, Naranjo D, Messer LH, Klonoff DC, Barnard-Kelly K. Healthcare Professional Experiences and Opinions on Depression and Suicide in People With Diabetes. J Diabetes Sci Technol 2024; 18:667-675. [PMID: 37162023 PMCID: PMC11089883 DOI: 10.1177/19322968231171616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE People with diabetes have an increased risk of depression, intentional self-injury and self-harm (ISI), and suicide compared with the general population. This study aimed to explore experiences and awareness of healthcare professionals (HCPs) regarding depression, ISI, and suicide, and understand resource use and needs among HCPs who care for persons with diabetes (PWD). METHODS Healthcare professionals who see children and/or adults with type 1 diabetes or type 2 diabetes anonymously completed an online survey about their experiences, opinions, barriers, and needs surrounding identification and care of PWD with depression, ISI, and suicide. RESULTS One hundred twenty-nine HCPs participated. The majority were medical doctors (MDs) or advanced practice providers (APPs). Only a quarter of MDs and APPs felt very comfortable asking about ISI or suicidal ideation (SI), whereas 20% felt they had received appropriate training to support those with ISI or SI. The primary needs reported include more training on how to ask, respond, and support those expressing ISI and SI. Healthcare professionals reported wanting better access to resources for PWD. DISCUSSION The HCPs tend to underestimate SI in the diabetes population and rates of training were low. Areas to address include providing education and training to HCPs to improve identification and management of ISI and suicide risk. These data can inform the development of mechanisms to improve discussions of depression and suicide and of resources to help HCPs support PWD.
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Affiliation(s)
- Shideh Majidi
- Division of Endocrinology, Children’s National Hospital, Washington, DC, USA
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Cohen
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard I. G. Holt
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Clements
- Pediatrics, Endocrinology, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Simon O’Neill
- Health Intelligence and Professional Liaison, Diabetes UK, London, UK
| | - Eric Renard
- Department of Endocrinology and Diabetes, Montpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Doug Tynan
- Jefferson Medical College, Philadelphia, PA, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Laurel H. Messer
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Cocozza V, Sickbert L, Kenny T, Espinola D, Welsh S, Turner Z, Pieroni K. Increasing Mental Health Screening in Pediatric Subspecialty Clinics: An Improvement Project at Brooke Army Medical Center. Mil Med 2024; 189:e789-e794. [PMID: 37748174 DOI: 10.1093/milmed/usad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Mental health screening allows for the early identification of patients at risk of mental health disorders such as anxiety and depression. The Defense Health Administration Procedures Manual 6025.01 established that patients older than 12 years of age should receive annual mental health screening assessing suicidality risk with a standardized screening tool. MATERIALS AND METHODS To improve rates of mental health screening in this at-risk population, an A3 Lean approach to quality improvement was undertaken in the Pediatric Subspecialty Clinics at Brooke Army Medical Center. RESULTS Baseline data of Patient Health Questionnaire-9 or General Anxiety Disorder-7 screening from pediatric pulmonology and cardiology clinics were 6.3%. Plan-Do-Study-Act quality improvement methods evaluated possible interventions to improve screening. A standard operating procedure (SOP) outlining scoring and interpretation recommendations was distributed in pediatric pulmonology and cardiology clinics. Using the Armed Forces Health Longitudinal Technology Application, a post-implementation chart review was conducted for 8 weeks. With the initiation of Military Health System Genesis, the SOP was adjusted and a root cause analysis was performed. The pediatric gastroenterology clinic cares for patients presenting with functional abdominal pain; therefore, the clinic was added to the second iteration to determine if anxiety or depression may play a role. Providers were educated on documentation and coding. A second post-implementation chart review was conducted for 8 weeks. Over two iterations, mental health screening of new adolescent patients in pediatric subspecialty clinics increased by 794% from baseline. Our providers screened 50% of the adolescent patients. CONCLUSIONS With increased surveillance of an at-risk population, more adolescents will receive the standard of care. With refinement of the SOP and expansion to other subspecialties, this project has the potential to expand within Brooke Army Medical Center and other clinics in the Defense Health Administration.
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Affiliation(s)
- Victoria Cocozza
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Lydia Sickbert
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Timothy Kenny
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Dimas Espinola
- Pediatric Subspecialty Clinic, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Sebastian Welsh
- Department of Pediatric Pulmonology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Zachary Turner
- Department of Pediatric Cardiology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Kevin Pieroni
- Department of Pediatric Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Soares Ferreira Junior A, Pinheiro Maux Lessa M, Kaplan S, Coles TM, Terrell DR, Onwuemene OA. Patient-Reported Outcome Measures in Patients with Thrombotic Thrombocytopenic Purpura: A Systematic Review of the Literature. J Clin Med 2023; 12:5155. [PMID: 37568558 PMCID: PMC10420299 DOI: 10.3390/jcm12155155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Health-related quality of life (HRQoL) impacts of thrombotic thrombocytopenic purpura (TTP) have been captured in clinical studies using patient-reported outcome (PRO) measures (PROMs) that are validated for other diseases. However, the validity evidence to support the use of existing PROMs in patients with TTP is unknown. In a systematic review of the literature, including studies of adults and children with TTP, we assessed the validity evidence for use of PROMs in clinical research and clinical practice, characterized HRQoL, described the integration of PROMs in clinical practice and evaluated PRO scores for patients with TTP compared with reference populations. From an initial 4518 studies, we identified 14 studies using 16 PROMs to assess general HRQoL domains in patients in remission. No identified studies assessed the validity of PROMs for the context of use of TTP and no studies described PROM integration into TTP clinical practice or evaluated PROMs that were specific for patients with TTP. Moreover, PRO scores were worse in patients with TTP compared with reference populations and other chronic conditions. We conclude that, in patients with TTP, PROMs pick up on important patient experiences not captured by clinical outcomes at present. There is, therefore, a need for studies that assess the validity of existing PROMs in patients with TTP to determine if TTP-specific PROMs specific to patients with TTP should be developed.
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Affiliation(s)
| | - Morgana Pinheiro Maux Lessa
- Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, São Paulo, Brazil
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University Medical Center, Durham, NC 27710, USA;
| | - Theresa M. Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Deirdra R. Terrell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Oluwatoyosi A. Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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Corathers S, Williford DN, Kichler J, Smith L, Ospelt E, Rompicherla S, Roberts A, Prahalad P, Basina M, Muñoz C, Ebekozien O. Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network. Curr Diab Rep 2023; 23:19-28. [PMID: 36538250 PMCID: PMC9763798 DOI: 10.1007/s11892-022-01497-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Desireé N Williford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Laura Smith
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Priya Prahalad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marina Basina
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cynthia Muñoz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA
- University of Mississippi School of Population Health, Jackson, MS, USA
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Marker AM, Patton SR, Clements MA, Egan AE, McDonough RJ. Adjusted Cutoff Scores Increase Sensitivity of Depression Screening Measures in Adolescents With Type 1 Diabetes. Diabetes Care 2022; 45:2501-2508. [PMID: 35984419 DOI: 10.2337/dc22-0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To measure the acceptability and diagnostic accuracy of commonly used depression screening measures to determine ideal cutoff scores that sensitively identify depressive disorders in adolescents with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS One hundred adolescents (12-17 years old) completed a reference standard, semistructured diagnostic interview and both long and short versions of five commonly used depression screening measures in the United States. To assess feasibility and acceptability, we used screener completion time and participant ratings, respectively. We used descriptive statistics, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve to assess each measure's diagnostic validity against our reference standard and to determine ideal cutoff scores for this sample. RESULTS Adolescents had a mean age of 15.0 ± 1.7 years, time since T1D diagnosis of 6.0 ± 4.1 years, and glycated hemoglobin (HbA1c) of 8.9 ± 1.8%. Sixty percent of adolescents were male, 15% endorsed a current depressive disorder, and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (0.33-0.67) to detect current depressive disorders using preexisting cutoff scores. However, adjusted cutoff scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated "good" to "excellent" predictive validity, and the Children's Depression Inventory-2 Short version demonstrated significantly greater diagnostic accuracy than the Patient Health Questionnare-2 item version for adolescents. CONCLUSIONS Clinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cutoff scores to increase sensitivity and reduce false negatives.
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Affiliation(s)
| | | | | | - Anna E Egan
- Children's Mercy-Kansas City, Kansas City, MO
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Schmidt M, Lu J, Luo W, Cheng L, Lee M, Huang R, Weng Y, Kichler JC, Corathers SD, Jacobsen LM, Albanese-O′Neill A, Smith L, Westen S, Gutierrez-Colina AM, Heckaman L, Wetter SE, Driscoll KA, Modi A. Learning experience design of an mHealth self-management intervention for adolescents with type 1 diabetes. EDUCATIONAL TECHNOLOGY RESEARCH AND DEVELOPMENT : ETR & D 2022; 70:2171-2209. [PMID: 36278247 PMCID: PMC9580427 DOI: 10.1007/s11423-022-10160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.
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Affiliation(s)
- Matthew Schmidt
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Jie Lu
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Wenjing Luo
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Li Cheng
- Worcester Polytechnic Institute, Worcester, USA
| | - Minyoung Lee
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Rui Huang
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Yueqi Weng
- College of Education, Purdue University, West Lafayette, USA
| | | | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | | | | | - Laura Smith
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | | | - Leah Heckaman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sara E. Wetter
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Kimberly A. Driscoll
- University of Florida Diabetes Institute, Gainesville, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Avani Modi
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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Feldman MA, Yardley HL, Bulan A, Kamboj MK. Role of Psychologists in Pediatric Endocrinology. Pediatr Clin North Am 2022; 69:905-916. [PMID: 36207101 DOI: 10.1016/j.pcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The care of youth managed within pediatric endocrine clinics is complex and requires a multi- or interdisciplinary approach. Psychosocial aspects of chronic health conditions are well-documented. Clinical practice guidelines outline the importance of routine psychosocial screening and support for youth with diabetes and obesity. This article outlines the diverse role of psychologists in pediatric endocrinology, including screening, in-clinic intervention, outpatient psychological services, and inpatient consultation. Although research exists documenting the effectiveness of behavioral interventions to improve adherence and health-related quality of life, cost analysis research is emerging.
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Affiliation(s)
- Marissa A Feldman
- Department of Psychology, Johns Hopkins All Children's Hospital, Saint Petersburg, 880 Sixth Street South, Suite 460, Saint Petersburg, FL 33701, USA.
| | - Heather L Yardley
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ayse Bulan
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Patton SR, Pierce JS, Fox L, Benson M, Mc Donough R, Clements MA. Remedy to Diabetes Distress (R2D2): Development protocol for a scalable screen-to-treat program for families of school-age children. Contemp Clin Trials 2022; 119:106829. [PMID: 35716992 DOI: 10.1016/j.cct.2022.106829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND School-age children with type 1 diabetes (T1D) need help from parents or other adult caregivers (caregivers) to effectively manage T1D, resulting in greater vulnerability to Diabetes Distress (DD) for both children and caregivers. Unfortunately, there are no scalable screen-to-treat programs for clinics to adopt to identify and treat DD in school-age families. METHODS AND ANALYSES We aim to design a scalable, clinic-based screen-to-treat program for DD in families of school-age children and to test whether our new program to reduce caregiver and child DD also reduces child glycemic levels. Our Remedy to Diabetes Distress (R2D2) program will target caregivers and children with T1D who are between 8 and 12 years old. It will merge routine and automated surveillance of DD in the clinical setting with at home digital delivery of a theory-based behavioral and psychological treatment of DD. We will use the ORBIT Model for Behavioral Intervention development to guide four small and cost-effective formative studies to develop our R2D2 program and assess initial treatment effects. In tandem, we will implement clinic-based DD screening in school-age families and assess feasibility and acceptability of our screening platform as a Quality Improvement activity. The study started in September 2020 and is scheduled to conclude in 2025. CONCLUSIONS The study will use a single Institutional Review Board (IRB) with Children's Mercy-Kansas City operating as the IRB of record. We will disseminate study results through presentations at scientific conferences and through peer-reviewed journals read by the psychology and diabetes care communities.
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Affiliation(s)
- Susana R Patton
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Jessica S Pierce
- Nemours Children's Health-Florida, 6900 Lake Nona Blvd, Orlando, FL 32827, United States of America.
| | - Larry Fox
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Matthew Benson
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Ryan Mc Donough
- Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America.
| | - Mark A Clements
- Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America.
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Jacob H, Marlais M. Safeguarding children and young people requiring kidney replacement therapy: challenges and potential opportunities. Pediatr Nephrol 2022; 37:1007-1015. [PMID: 34247294 DOI: 10.1007/s00467-021-05133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Kidney replacement therapy (KRT) makes considerable physical and psychological demands on children, young people and their families. The impact can be wide-ranging, affecting education, employment, mental health, finances and relationships for both child and caregiver. It is vitally important for those working with these families to recognise the psychosocial challenges they face and to know the range of interventions available. This article explores the psychosocial impact of KRT, considering opportunities to minimise risk and optimise outcomes for children, young people and their families.
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Affiliation(s)
- Hannah Jacob
- Department of Nephrology, Great Ormond Street Hospital, London, UK.
| | - Matko Marlais
- Department of Nephrology, Great Ormond Street Hospital, London, UK
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Baechle C, Stahl-Pehe A, Castillo K, Lange K, Holl RW, Rosenbauer J. Course of screening-based depression in young adults with a long type 1 diabetes duration: Prevalence and transition probabilities - A cohort study. Diabetes Res Clin Pract 2022; 185:109220. [PMID: 35104568 DOI: 10.1016/j.diabres.2022.109220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
AIMS To extend the current knowledge of the prevalence and course of screening-based depression (SBD) and its predictors in emerging adults with a long type 1 diabetes duration. METHODS A total of 487 young adults (64.7% women, mean age 24.0 years) who participated in a nationwide cohort study provided data on SBD (Patient Health Questionnaire (PHQ-9) score ≥ 10). We estimated the overall and age- and sex-specific prevalence of SBD, identified the associated covariates, and determined the transition probabilities between SBD states using adjusted first-order Markov transition models. RESULTS The prevalence of SBD was 17.7% in women and 7.0% in men. A total of 70.4% (95%-CI 57.4%; 80.8%) of the participants with SBD at the first screening still had SBD at the three-year follow-up. Of the subjects without SBD at baseline, 6.9% (4.9%; 9.8%) had SBD at follow-up. The main predictor of current SBD was previous SBD (OR 39.0 (15.4; 98.6)), followed by living in one's own or in a shared apartment vs. living with both parents (OR: 2.75 (1.03; 7.36)). CONCLUSIONS Using an innovative analytical approach, emerging adults with a long diabetes duration demonstrated a moderate rate of incident SBD but a high rate of persistent SBD.
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Affiliation(s)
- Christina Baechle
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Katty Castillo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Wigglesworth KR, Vigers T, Pyle L, Youngkin EM, Fay-Itzkowitz E, Tilden J, Raymond JK, Snell-Bergeon J, Sass A, Majidi S. Follow-Up Mental Health Care in Youth and Young Adults With Type 1 Diabetes After Positive Depression Screen and/or Suicidal Ideation. Clin Diabetes 2022; 40:449-457. [PMID: 36385972 PMCID: PMC9606559 DOI: 10.2337/cd21-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained.
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Affiliation(s)
- Kelly R.S. Wigglesworth
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy Vigers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin M. Youngkin
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ellen Fay-Itzkowitz
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer Tilden
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer K. Raymond
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy Sass
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, DC
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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13
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Richardson GM, Urbanowicz E, Taher T, Hasan R. Teaching Evidence-Based Medicine Through Facilitated Journal Clubs. PRIMER (LEAWOOD, KAN.) 2021; 5:47. [PMID: 35178509 PMCID: PMC8842802 DOI: 10.22454/primer.2021.441926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Gina M Richardson
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Erin Urbanowicz
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Tajwar Taher
- Rutgers-RWJ Somerset Family Medicine Residency, Somerville, NJ
| | - Reem Hasan
- Department of Internal Medicine, Oregon Health & Science University, Portland, OR | Department of Pediatrics, Oregon Health & Science University, Portland, OR
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14
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Mulvaney SA, Mara CA, Kichler JC, Majidi S, Driscoll KA, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Hood KK, Monaghan M. A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care. Transl Behav Med 2021; 11:122-131. [PMID: 31764981 DOI: 10.1093/tbm/ibz171] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.
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Affiliation(s)
| | - Constance A Mara
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica C Kichler
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | | | | | | | - Korey K Hood
- Stanford University School of Medicine, Palo Alto, CA, USA
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15
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Ginnard OZ, Alonso GT, Corathers SD, Demeterco-Berggren C, Golden LH, Miyazaki BT, Nelson G, Ospelt E, Ebekozien O, Lee JM, Obrynba KS, DeSalvo DJ. Quality Improvement in Diabetes Care: A Review of Initiatives and Outcomes in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2021; 39:256-263. [PMID: 34421200 PMCID: PMC8329011 DOI: 10.2337/cd21-0029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Despite immense strides in therapeutic advances, clinical outcomes continue to be less than ideal for people with type 1 diabetes. This discrepancy has prompted an outpouring of quality improvement (QI) initiatives to address the medical, psychosocial, and health equity challenges that complicate ideal type 1 diabetes care and outcomes. This article reviews a framework for QI in diabetes care that guided the development of the T1D Exchange Quality Improvement Collaborative to improve care delivery and health outcomes in type 1 diabetes. Evaluation of the methodology, outcomes, and knowledge gained from these initiatives will highlight the importance of continued QI initiatives in diabetes care.
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Affiliation(s)
| | - G. Todd Alonso
- Barbara Davis Center, University of Colorado, Aurora, CO
| | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | | | | | | | | | - Joyce M. Lee
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
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16
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Brodar KE, Davis EM, Lynn C, Starr-Glass L, Lui JHL, Sanchez J, Delamater AM. Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatr Diabetes 2021; 22:656-666. [PMID: 33604976 DOI: 10.1111/pedi.13193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. RESEARCH DESIGN AND METHODS Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c). RESULTS Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eighty-three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. CONCLUSIONS Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.
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Affiliation(s)
- Kaitlyn E Brodar
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eileen M Davis
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Courtney Lynn
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lolly Starr-Glass
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joyce H L Lui
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Janine Sanchez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alan M Delamater
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Vlahou CH, Petrovski G, Korayem M, Al Khalaf F, El Awwa A, Mahmood OM, Azeem MW. Outpatient clinic-wide psychological screening for children and adolescents with type 1 diabetes in Qatar: An initiative for integrative healthcare in the Gulf region. Pediatr Diabetes 2021; 22:667-674. [PMID: 33715298 DOI: 10.1111/pedi.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To identify culturally appropriate psychological screening measures for children and adolescents with type 1 diabetes in Qatar, determine rates of depressive and anxiety symptoms in a clinical sample, and examine associations between screening measures, demographic variables, medical characteristics, and diabetes treatment outcomes, specifically HbA1c. METHODS A total of 150 participants with type 1 diabetes aged 10-17 were recruited. Participants were Arabic or English speaking and of Qatari and non-Qatari nationality. Participants completed the Mood and Feelings Questionnaire (child and parent proxy form), the Spence Children's Anxiety Scale, and the Pediatric Quality of Life, Diabetes version (child and parent proxy form). Glycosylated hemoglobin (HbA1c) on the date of the testing was recorded. RESULTS Approximately ten percent (10.2%) of children and adolescents scored above the cutoff score of 27 indicating clinically significant depressive symptoms, and 12.8% of parents rated their child above the respective cutoff score of 21 for the parent proxy form. Further, 36% of the sample reported clinically significant anxiety symptoms, scoring above the cutoff score of 50. Parent report on their child's quality of life predicted HbA1c (F[6, 140] = 5.42, p = 0.000); B = -0.05, p = 0.002). CONCLUSIONS Rates of depressive and anxiety symptoms are comparable to those observed in western countries. Thus, systematic screening for depression and anxiety in children and adolescents with type 1 diabetes should be implemented in Qatar. This will help inform decisions to refer to mental health services and thus provide more integrated care, possibly improving treatment outcomes.
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Affiliation(s)
- Christina H Vlahou
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Goran Petrovski
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Mona Korayem
- Department of Psychiatry, Sidra Medicine, Doha, Qatar
| | - Fawziya Al Khalaf
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Ahmed El Awwa
- Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar.,Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar M Mahmood
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Muhammed Waqar Azeem
- Department of Psychiatry, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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18
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Electronic Mental Health Screening in a Pediatric Heart Failure and Transplant Clinic. J Clin Psychol Med Settings 2021; 28:815-825. [PMID: 33772706 DOI: 10.1007/s10880-021-09770-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Adults with heart failure and transplant are at increased risk for psychiatric comorbidities. The prevalence and impact of psychiatric comorbidities have not been well studied in pediatric heart failure and transplant. This quality improvement project sought to evaluate the feasibility of utilizing electronic mental health screening measures during pediatric heart failure and transplant clinics and to explore the prevalence and severity of self-reported depressive, anxiety, and suicidal ideation symptoms. Patients aged 11 years and older who presented to a pediatric heart failure and transplant clinic were administered the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Medical chart review and a survey were used to examine additional variables of interest. There were no significant differences in moderate and severe mental health symptoms between gender, medical diagnoses, or those with recent hospitalizations. Pediatric patients with heart failure or transplant reported higher prevalence of anxiety and depressive symptoms, and similar suicidal ideation compared to the general adolescent population. Moreover, rates of depression and anxiety symptoms as well as suicidal ideation were comparable to pediatric patients with diabetes, lupus, inflammatory bowel disease, and cystic fibrosis. Results suggest electronic mental health screening is feasible for use during outpatient cardiology clinic visits and provides valuable mental health information.
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19
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Shapira A, Volkening LK, Markowitz JT, Butler DA, Laffel LM. Mental Health Providers' Assessment of Parents' Reactions to their Children's Elevated Depressive Symptoms. Pediatr Diabetes 2021; 22:354-359. [PMID: 33030293 PMCID: PMC8988090 DOI: 10.1111/pedi.13138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022] Open
Abstract
This study assessed parental reactions to the report of elevated depressive symptoms in a sample of 29 youth with type 1 diabetes (ages 8-17 years; 48% female) who scored ≥15 on the Center for Epidemiologic Studies Depression Scale for Children (CES-DC). We also assessed parental depressive symptoms and how the presence of such symptoms was linked to parental reactions to the report of a positive screening score in their children and subsequent acceptance of a mental health referral. Mental health professionals contacted parents to discuss elevated scores and offer a mental health referral. Two coders reviewed the documentation of phone contacts made by mental health professionals and categorized parental responses to their child's elevated CES-DC score and the disposition plan. Youth and parent depressive symptoms were modestly correlated (r = 0.21, P = .01). About half (55%, 16/29) of parents were unaware of their child's depressive symptoms. Only 14% (4/29) of youth were already receiving mental health care while 28% (8/29) of parents accepted a referral. Parents with depressive symptoms were frequently unaware of their child's symptoms. Findings provide insight into parental reactions to learning of their child's depressive symptoms and highlight the need for more research on parental mood and reactions to their child's positive screen for depressive symptoms, as a potential barrier to mental health referral acceptance.
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Affiliation(s)
- Amit Shapira
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
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20
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Trafalis S, Giannini C, Joves J, Portera S, Toyama H, Mehta A, Basile K, Friedberg RD. A pediatrician-friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations. Pediatr Investig 2021; 5:58-64. [PMID: 33778429 PMCID: PMC7984009 DOI: 10.1002/ped4.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
Behavioral health concerns are surging in pediatric practices. Fortunately, integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load. Routine screening of behavioral health problems in primary care facilities enables early identification and treatment. However, deciding on sound, efficient, and scalable screening measures is sometimes arduous. Accordingly, this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety, depression, and conduct problems. Psychometric findings and clinical applications of the Pediatric Symptom Checklist-17 (PSC-17), the Patient Health Questionnaire-9 (PHQ-9), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) are delineated. Finally, clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.
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Affiliation(s)
- Sandra Trafalis
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Courtney Giannini
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Jeremy Joves
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Saige Portera
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Hannah Toyama
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Anika Mehta
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Krista Basile
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Robert D. Friedberg
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
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21
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Monaghan M, Mara CA, Kichler JC, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Stone JY, Hood KK, Mulvaney SA. Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes. Can J Diabetes 2021; 45:411-416. [PMID: 33722492 DOI: 10.1016/j.jcjd.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. METHODS The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. RESULTS Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. CONCLUSIONS Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia, United States.
| | - Constance A Mara
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Alana Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Laura M Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, United States
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jenine Y Stone
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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22
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Davis S, Crerand C, Hutaff-Lee C, Thompson T, Tishelman A, Samara O, Umbaugh H, Nahata L, Kremen J. Neurodevelopmental and Mental Health Screening for Patients with Turner Syndrome in Pediatric Endocrine Clinics: Results of a Pediatric Endocrine Society Survey. Horm Res Paediatr 2020; 93:643-650. [PMID: 33915553 PMCID: PMC8205091 DOI: 10.1159/000516126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION International Turner syndrome (TS) Clinical Practice Guidelines recommend screening for neurodevelopmental (ND) and mental health (MH) concerns in girls with TS; however, it remains unclear whether this is implemented in current practice. The objective of this mixed methods study was to assess screening practices for ND and MH in girls with TS from the perspective of pediatric endocrinologists. METHODS Pediatric Endocrine Society members who provide care for girls with TS were invited to complete an electronic survey on screening practices. Descriptive statistics were used to summarize quantitative results concurrently with thematic analysis of free-text survey responses. RESULTS A total of 124 surveys were completed (86% attending pediatric endocrinologists, 81% at academic institutions). Overall, 25% of providers reported their patients with TS received both ND and MH screenings. Only 9 (9%) respondents endorsed screening for ND concerns themselves, while more providers (26%) reported they screen for MH concerns. Multiple barriers to screening for ND and MH concerns within the clinical setting were endorsed. Nearly all providers (>93%) reported they would consider using a short, validated screening tool for ND and MH concerns if such tools were available. DISCUSSION A minority of pediatric endocrinologists currently perform ND or MH screening for patients with TS, however, many would be interested in implementing a brief screening tool into their clinical practice. Given almost all girls with a TS diagnosis receive care from pediatric endocrinologists at least annually, this may be an effective method to increase the proportion of girls with TS who receive recommended screenings.
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Affiliation(s)
- Shanlee Davis
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA,eXtraOrdinary Kids Turner Syndrome Clinic,
Children’s Hospital Colorado, Aurora, CO, USA
| | - Canice Crerand
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA,eXtraOrdinary Kids Turner Syndrome Clinic,
Children’s Hospital Colorado, Aurora, CO, USA
| | - Talia Thompson
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Amy Tishelman
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA,Division of Endocrinology, Boston Children’s
Hospital, Boston, MA, USA
| | - Omar Samara
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Hailey Umbaugh
- Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Jessica Kremen
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA,Division of Endocrinology, Boston Children’s
Hospital, Boston, MA, USA
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23
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Barry-Menkhaus SA, Stoner AM, MacGregor KL, Soyka LA. Special Considerations in the Systematic Psychosocial Screening of Youth with Type 1 Diabetes. J Pediatr Psychol 2019; 45:299-310. [DOI: 10.1093/jpepsy/jsz089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/20/2019] [Accepted: 10/02/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract
Objective
The American Diabetes Association recommends psychosocial screening for individuals with type 1 diabetes (T1D). The purpose of this study is to present (a) several high priority decisions that program developers may encounter when building a new psychosocial screening program and (b) both the screening development process and results of one mental health screening program within a multidisciplinary pediatric diabetes clinic, with particular emphasis on parent-youth screening agreement and changes to elevation status over time.
Methods
Youth with T1D ages 12–17 and parents of youth with T1D ages 8–17 were administered mental health screeners as a part of outpatient diabetes visits over a 1-year period. Youth depression and anxiety were screened using self- and parent proxy-report versions of the Patient-Reported Outcomes Measurement Information System (PROMIS).
Results
Youth (n = 154) and parents (n = 211) completed mental health screening measures, such that 228 youth were screened. Intraclass correlation coefficients (ICCs) between youth- and parent proxy-report agreement were good for the measures of depression (ICC = .787) and anxiety (ICC = .781), with parent proxy-reports significantly higher than youth self-reports of anxiety (p < .01). Of the 93 youth with follow-up screening data and no youth- or parent proxy-reported elevation on the initial screener, 16.1% had at least one elevated screener within 1 year.
Conclusions
Findings indicate that questions of who to screen and how often to screen may deserve increased scrutiny, as this screening program’s data suggest that there may be benefit to obtaining both youth- and parent report more often than annually.
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Affiliation(s)
| | | | | | - Leslie A Soyka
- University of Massachusetts Memorial Medical Center & UMass Medical School
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