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Savill M, Loewy RL, Niendam TA, Porteus AJ, Rosenthal A, Gobrial S, Meyer M, Bolden KA, Lesh TA, Ragland JD, Carter CS. The diagnostic accuracy of screening for psychosis spectrum disorders in behavioral health clinics integrated into primary care. Schizophr Res 2024; 266:190-196. [PMID: 38422889 PMCID: PMC11140870 DOI: 10.1016/j.schres.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
Screening for psychosis spectrum disorders in primary care could improve early identification and reduce the duration of untreated psychosis. However, the accuracy of psychosis screening in this setting is unknown. To address this, we conducted a diagnostic accuracy study of screening for psychosis spectrum disorders in eight behavioral health services integrated into primary care clinics. Patients attending an integrated behavioral health appointment at their primary care clinic completed the Prodromal Questionnaire - Brief (PQ-B) immediately prior to their intake assessment. This was compared to a diagnostic phone interview based on the Structured Interview for Psychosis Risk Syndromes (SIPS). In total, 145 participants completed all study procedures, of which 100 screened positive and 45 negative at a provisional PQ-B threshold of ≥20. The PQ-B was moderately accurate at differentiating psychosis spectrum from no psychosis spectrum disorders; a PQ-B distress score of ≥27 had a sensitivity and specificity of 71.2 % and 57.0 % respectively. In total, 66 individuals (45.5 %) met criteria for a psychosis spectrum disorder and 24 (16.7 %) were diagnosed with full psychosis, indicating a high prevalence of psychosis in the sample. Overall, screening for psychosis spectrum disorders in an IBH primary care setting identified a relatively high number of individuals and may identify people that would otherwise be missed. The PQ-B performed slightly less well than in population-based screening in community mental health settings. However, the findings suggest this may represent an effective way to streamline the pathway between specialty early psychosis programs and primary care clinics for those in need.
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Affiliation(s)
- Mark Savill
- University of California, Davis, United States of America.
| | - Rachel L Loewy
- University of California, San Francisco, United States of America
| | - Tara A Niendam
- University of California, Davis, United States of America
| | | | - Adi Rosenthal
- University of California, Davis, United States of America
| | - Sarah Gobrial
- University of California, Davis, United States of America
| | - Monet Meyer
- University of California, Davis, United States of America
| | | | - Tyler A Lesh
- University of California, Davis, United States of America
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Garza C, Chapa D, Hernandez C, Aramburu H, Mayes TL, Emslie GJ. Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01652-4. [PMID: 38217644 DOI: 10.1007/s10578-023-01652-4] [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] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.
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Affiliation(s)
- Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA.
| | - Diana Chapa
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Catherine Hernandez
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Hayley Aramburu
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Graham J Emslie
- Children's Health, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hodgson CG, Bonifay W, Yang W, Herman KC. Establishing the measurement precision of the patient health questionnaire in an adolescent sample. J Affect Disord 2023; 342:76-84. [PMID: 37708980 DOI: 10.1016/j.jad.2023.09.013] [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: 04/18/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Technically sound measures are necessary for accurately identifying youth at risk for depression, but many studies rely on classical test theory metrics or adult samples to evaluate measures. This study examined the use of the PHQ-8, a common and freely available pediatric depression screener, in an adolescent sample using item response theory (IRT). METHODS Secondary analyses were conducted on data from a study conducted in Midwestern middle schools in which 1224 youth completed the PHQ-8 as part of a battery of surveys. Polytomous IRT analyses (a Graded Response Model) were used to evaluate the PHQ-8. Items were examined for their ability to distinguish between respondents of different latent depression severity and for differential item functioning (DIF) across demographic categories. RESULTS All PHQ-8 items had adequate discriminative abilities. Items measuring anhedonia and psychomotor disturbances performed relatively poorly, and items measuring somatic symptoms (appetite and sleep) were most informative when respondents endorsed extreme response options ("not at all" or "nearly every day"). No DIF was found across grade level or race, but several items were flagged for DIF by gender and student income level. LIMITATIONS These results might not be generalizable to a broader youth population due to administration setting and the unique demographic characteristics of this sample (76.0 % African American). CONCLUSIONS Tools such as the PHQ-8 are appropriate to quickly screen for depression in adolescents, but further scrutiny of adolescent response patterns is warranted. Future research should examine items measuring anhedonia and psychomotor and somatic disturbances in adolescents.
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Affiliation(s)
| | - Wes Bonifay
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA
| | - Wenxi Yang
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA.
| | - Keith C Herman
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA
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Doan TT, DeJonckheere M, Wright DR, Hutton DW, Prosser LA. Preferences and experiences of pediatricians on implementing national guidelines on universal routine screening of adolescents for major depressive disorder: A qualitative study. Compr Psychiatry 2023; 127:152412. [PMID: 37717343 DOI: 10.1016/j.comppsych.2023.152412] [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: 04/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND To explore the preferences of pediatricians for key factors around the implementation of universal routine screening guidelines for major depressive disorder in adolescent patients in a primary care setting. METHOD Semi-structured qualitative interviews were conducted with U.S. pediatricians. Participants were recruited by convenience sampling and snowball sampling. Qualitive data were summarized using thematic analysis to identify themes relevant to preferences around implementing screening strategies for adolescent patients. Recruitment ended upon reaching thematic saturation when no new themes were revealed. RESULTS Of the 14 participants, 11 identified as female, 3 male, 10 white, and 4 Asian. Top themes among pediatrician participants were around the screening modality (14/14 participants), screening validity (14/14), time barriers (14/14), and confidentiality barriers (12/14). Less frequently mentioned themes by pediatricians were workplace coordination and logistics (7/14), alternative starting ages for screening (7/14), more frequent screenings than annual screenings (3/14), and additional clinical training regarding depression diagnosis and treatment (2/14). LIMITATIONS Pool of interviewed participants was limited by diversity in terms of geography, race/ethnicity, or practice settings. CONCLUSIONS To promote the uptake of universal routine screening of adolescent major depression, pediatricians expressed it was important to address key implementation factors regarding the screening modality, screening validity, time constraints, and confidential care concerns in a primary care delivery context. Findings could be used to inform the development of implementation strategies to facilitate depression screening in primary care. Future research is needed to quantitively assess decisions and tradeoffs that pediatricians make when implementing universal screening to support adolescent mental health.
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Affiliation(s)
- Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
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Hamdan SZ, Davis M, Faig W, Guthrie W, Yerys BE, Wallis KE. Lower Completion of Depression Screening and Higher Positivity Among Autistic Adolescents Across a Large Pediatric Primary Care Network. Acad Pediatr 2023; 23:1561-1571. [PMID: 37393034 PMCID: PMC10755081 DOI: 10.1016/j.acap.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To examine rates of depression screening and positivity among autistic adolescents where electronic depression screening is administered universally; to compare rates between autistic and nonautistic youth; and to explore sociodemographic and clinical factors associated with screening completion and results. METHODS We conducted a retrospective cohort study comparing 12-17-year-old autistic and nonautistic adolescents presenting for well-child care in a large pediatric primary care network between November 2017 and January 2019 (N = 60,181). Sociodemographic and clinical data, including PHQ-9-M completion status and results, were extracted digitally from the electronic health record and compared between autistic and nonautistic youth. Logistic regression explored the relationship between sociodemographic and clinical factors and screen completion and results, stratified by autism diagnosis. RESULTS Autistic adolescents were significantly less likely to have a completed depression screen compared to nonautistic adolescents [67.0% vs 78.9%, odds ratio (OR) = 0.54, P < .01]. Among those with a completed screen, a higher percentage of autistic youths screened positive for depression (39.1% vs 22.8%; OR = 2.18, P < .01,) and suicidal ideation/behavior (13.4% vs 6.8%; OR = 2.13, P < .01). Factors associated with screening completion and positivity differed between autistic and nonautistic groups. CONCLUSIONS Autistic adolescents were less likely to have a completed depression screen when presenting for well-child care. However, when screened, they were more likely to endorse depression and suicide risk. This suggests disparities in depression screening and risk among autistic youth compared to nonautistic youth. Additional research should evaluate the source of these disparities, explore barriers to screening, and examine longitudinal outcomes of positive results among this population.
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Affiliation(s)
- Samar Z Hamdan
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI) (M Davis), University of Pennsylvania, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Walter Faig
- Biostatistics and Data Management Core (W Faig), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Benjamin E Yerys
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
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Kass M, Alexander L, Moskowitz K, James N, Salum GA, Leventhal B, Merikangas K, Milham MP. Robust Parental Preferences in Mental Health Screening in Youth From a Multinational Online Survey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.09.23285610. [PMID: 36798244 PMCID: PMC9934784 DOI: 10.1101/2023.02.09.23285610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Importance Screening youth for mental disorders may assist in prevention, promote early identification, and reduce related lifetime impairment and distress. Objective The goal was to survey parents about their comfort and preferences for pediatric mental health screening, as well as factors associated with these preferences. Design The online survey was available July 11-14, 2021 on Prolific Academic. Analyses were conducted from November 2021 to November 2022. Setting Online survey. Participants The survey was administered to English-speaking parents with at least one 5-21-year old child at home. The sample included 972 parents, aged 21 and older, from the United States ( n =265), United Kingdom ( n =282), Canada ( n =171), and Other Countries ( n =254). Exposures None. Main Outcomes/Measures Parental preferences regarding the screening content, implementation preferences, and screener reviewing preferences of pediatric mental health screening were assessed in a novel survey. Mixed effects logistic models were employed to evaluate factors that influence parental comfort levels. Results Parents, aged 21 to 65 ( M =39.4; 62.3% female), supported annual mental health screening for their child and preferred reviewing the screening results with professional staff (e.g., physicians). Parents preferred parent-report over child self-reports, though they were generally comfortable with both options. Despite slight variations based on country of residence, screening topic, and child's age, parents were generally comfortable discussing all 21 topics. The greatest comfort was with sleep problems; the least comfort was with firearms, gender identity, suicidality, and substance use/abuse. Conclusions/Relevance Our data indicated that parents support annual parent- and child self-report mental health screening in primary care settings, but comfort levels differ according to various factors, such as screening topic. Parents preferred screening to occur in the healthcare office and to discuss screening results with professional staff. In addition to parental need for expert guidance, the growing awareness of child mental health needs highlights the importance of addressing mental health concerns early via regular mental health screenings. KEY POINTS Question: What are parents' attitudes towards pediatric mental health screening in primary care settings?Findings: The vast majority of parents surveyed online ( N=972) expressed comfort with the screening of children for mental health concerns in the primary care setting. Variations in comfort were noted in relation to age of child and topics included. Parents expressed a preference for parent report over child report, as well as for reviewing screening results with professional medical staff. These findings were robust to the country of residence (e.g., United States, Canada, United Kingdom). Meaning: Our findings document parental preferences that should be incorporated to enhance the feasibility of mental health screening in primary care settings.
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Davis A, Faerber J, Ardalan K, Katcoff H, Klein-Gitelman M, Rubinstein TB, Cidav Z, Mandell DS, Knight A. The Effect of Psychiatric Comorbidity on Healthcare Utilization for Youth With Newly Diagnosed Systemic Lupus Erythematosus. J Rheumatol 2023; 50:204-212. [PMID: 36109077 DOI: 10.3899/jrheum.220052] [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: 08/31/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the effect of psychiatric diagnoses on healthcare use in youth with systemic lupus erythematosus (SLE) during their first year of SLE care. METHODS We conducted a retrospective cohort study using claims from 2000 to 2013 from Clinformatics Data Mart (OptumInsight). Youth aged 10 years to 24 years with an incident diagnosis of SLE (≥ 3 International Classification of Diseases, 9th revision, codes for SLE 710.0, > 30 days apart) were categorized as having: (1) a preceding psychiatric diagnosis in the year before SLE diagnosis, (2) an incident psychiatric diagnosis in the year after SLE diagnosis, or (3) no psychiatric diagnosis. We compared ambulatory, emergency, and inpatient visits in the year after SLE diagnosis, stratified by nonpsychiatric and psychiatric visits. We examined the effect of childhood-onset vs adult-onset SLE by testing for an interaction between age and psychiatric exposure on outcome. RESULTS We identified 650 youth with an incident diagnosis of SLE, of which 122 (19%) had a preceding psychiatric diagnosis and 105 (16%) had an incident psychiatric diagnosis. Compared with those without a psychiatric diagnosis, youth with SLE and a preceding or incident psychiatric diagnosis had more healthcare use across both ambulatory and emergency settings for both nonpsychiatric and psychiatric-related care. These associations were minimally affected by age at time of SLE diagnosis. CONCLUSION Psychiatric comorbidity is common among youth with newly diagnosed SLE and is associated with greater healthcare use. Interventions to address preceding and incident psychiatric comorbidity may decrease healthcare burden for youth with SLE.
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Affiliation(s)
- Alaina Davis
- A. Davis, MD, MPH, Department of Pediatrics, Division of Pediatric Rheumatology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA;
| | - Jennifer Faerber
- J. Faerber, PhD, Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kaveh Ardalan
- K. Ardalan, MD, MS, Department of Pediatrics (Division of Pediatric Rheumatology), Duke University School of Medicine, Durham, North Carolina, and Departments of Pediatrics and Medical Social Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hannah Katcoff
- H. Katcoff, MPH, Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marisa Klein-Gitelman
- M. Klein-Gitelman, MD, MPH, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tamar B Rubinstein
- T.B. Rubinstein, MD, Department of Pediatrics, Division of Pediatric Rheumatology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Zuleyha Cidav
- Z. Cidav, PhD, Leonard Davis Institute of Health Economics, University of Pennsylvania, and Center for Mental Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Mandell
- D.S. Mandell, ScD, Center for Mental Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Knight
- A. Knight, MD, MSCE, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, and PolicyLab, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA, and Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada
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Ramtin S, Carberry K, Correa M, Ring D, Alter C, Shanor D. Mental Health Among People Presenting for Care of Physical Symptoms: The Factors Associated with Suicidality and Symptoms of Depression and Anxiety are Similar Across Specialties. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231169106. [PMID: 37101814 PMCID: PMC10123920 DOI: 10.1177/24705470231169106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023]
Abstract
Background To identify differences in thoughts of suicide and symptoms of depression and anxiety by specialty among people presenting for care of physical symptoms, we analyzed data from routine mental health measurement in a small multispecialty practice and asked: 1. Are there any differences in suicidality (analyzed as an answer of 1 or greater or 2 or greater on the Patient Health Questionnaire [PHQ] question 9) in non-specialty and various types of specialty care? 2. Are there any factors-including specialty-associated with symptoms of depression (mean PHQ score), PHQ thresholds (greater than 0, 3 or greater, 10 or greater), Generalized Anxiety Disorder instrument [GAD] score of 3 or greater, and either GAD score 3 or greater or PHQ score 3 or greater? and 3. What factors are associated with referral to a social worker? Methods As part of routine specialty and non-specialty care, 13,211 adult patients completed a measure of symptoms of depression (PHQ) that included a question about suicidality and a measure of symptoms of anxiety (GAD). Factors associated with suicidality and symptoms of depression and anxiety at various thresholds, and visit with a social worker, were sought in multivariable models. Results Accounting for potential confounding in multivariable analyses, a score higher than 0 on the suicidality question (present in 18% of people) was associated with men, younger age, English-speakers, and neurodegenerative specialty care. Symptoms of depression on their continuum and using various thresholds (28% of people had a PHQ score greater than 2) were associated with non-Spanish-speakers, younger age, women, and county insurance or Medicaid insurance. Care from the social worker was associated with PHQ score of 3 or greater and having any suicidal thoughts (score of 1 or greater on question 9) but was less common with Medicare or Commercial Insurance and less common in the unit treating cognitive decline. Conclusion The notable prevalence of symptoms of depression and suicidality among people presenting for care of physical symptoms across specialties and the relatively similar factors associated with suicidality, symptoms of depression, and symptoms of anxiety at various thresholds suggests that both non-specialty and specialty clinicians can be vigilant for opportunities for improved mental health. Increased recognition that people seeking care for physical symptoms often have mental health priorities has the potential to improve comprehensive care strategies, alleviate distress, and reduce suicide.
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Affiliation(s)
- Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Kathleen Carberry
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Maria Correa
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- David Ring, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building; MC Z0800, 1701 Trinity St. Austin, TX 78712, USA.
| | - Carol Alter
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Donna Shanor
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Davis M, Hoskins K, Phan M, Hoffacker C, Reilly M, Fugo PB, Young JF, Beidas RS. Screening Adolescents for Sensitive Health Topics in Primary Care: A Scoping Review. J Adolesc Health 2022; 70:706-713. [PMID: 34955356 PMCID: PMC9038619 DOI: 10.1016/j.jadohealth.2021.10.028] [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: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
We sought to aggregate common barriers and facilitators to screening adolescents for sensitive health topics (e.g., depression, chlamydia) in primary care, as well as those that are unique to a given health topic. We conducted a literature search of three databases (PsycInfo, MEDLINE, and CINAHL) and reference lists of included articles. Studies focused on barriers and facilitators to screening adolescents (ages 12-17 years) for sensitive health topics in primary care that are recommended by national guidelines. Articles were peer-reviewed, presented empirical data, and were published in English in 2006-2021. We coded barriers and facilitators using the Consolidated Framework for Implementation Research, a well-established framework within implementation science. In total, 39 studies met inclusion criteria and spanned several health topics: depression, suicide, substance use, HIV, and chlamydia. We found common barriers and facilitators to screening across health topics, with most relating to characteristics of the primary care clinics (e.g., time constraints). Other factors relevant to screening implementation ranged from confidentiality concerns to clinician knowledge. Barriers and facilitators specific to certain health topics, such as the availability of on-site laboratories for HIV screening, were also noted. Findings can guide refinements to screening implementation.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Katelin Hoskins
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Phan
- Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, USA
| | - Carlin Hoffacker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Reilly
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Perrin B. Fugo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, USA and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Gladstone TR, Feinstein RT, Fitzgibbon ML, Schiffer L, Berbaum ML, Lefaiver C, Pössel P, Diviak K, Wang T, Knepper AK, Sanchez-Flack J, Rusiewski C, Potts D, Buchholz KR, Myers TL, Van Voorhees BW. PATH 2 Purpose: Design of a comparative effectiveness study of prevention programs for adolescents at-risk for depression in the primary care setting. Contemp Clin Trials 2022; 117:106763. [DOI: 10.1016/j.cct.2022.106763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/18/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
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Woodrow N, Fairbrother H, Breheny K, d'Apice K, Albers PN, Mills C, Curtis M, Hopkins L, Tebbett S, Campbell R, De Vocht F. Exploring the potential of a school-based online health and wellbeing screening tool: professional stakeholders' perspectives and experiences. BMC Public Health 2022; 22:324. [PMID: 35168580 PMCID: PMC8848969 DOI: 10.1186/s12889-022-12748-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Supporting children and young people’s (CYP) mental and physical health is a global policy priority but detecting need and facilitating access to health services and support is challenging. This paper explores professional stakeholders’ perspectives of the acceptability, utility and effectiveness of a school-based online health and wellbeing screening tool, the Digital Health Contact (DHC). The DHC, delivered by Public Health School Nurses (PHSN), aims to identify, and put in place strategies to support, unmet health needs among CYP. Methods We employed a qualitative study design, using semi-structured interviews. Fourteen key stakeholders involved in the design and implementation of the DHC (commissioners, providers, PHSN and healthcare staff, school leaders) were purposively sampled. Data were analysed thematically. Results Our analysis generated two key themes: the perceived benefits of the DHC; and challenges in delivering the DHC. Stakeholders perceived the universal application of the DHC with linked follow-up intervention as an effective means of identifying and supporting CYP with unmet needs, and an efficient way to target limited service resources. There were barriers around enabling school engagement in the DHC, typically in terms of logistics, school infrastructure, and perspectives of fit with schools. These barriers were seen as being negated through developing effective working relationships between schools and PHSN. Effective relationships could highlight the potential benefits of participation. Overall, the DHC was seen as a valuable and effective use of resources, with a low burden on school staff. Conclusions The DHC, as a universal school-based health and wellbeing screening tool with linked follow-up intervention, has great potential in identifying and supporting unmet health needs among CYP. The perspectives and experiences of those involved in delivering the DHC highlight important considerations which may enable effective implementation and delivery of school screening programmes across other areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12748-2.
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Affiliation(s)
- Nicholas Woodrow
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, S1 4DA, Sheffield, UK.
| | - Hannah Fairbrother
- Health Sciences School, University of Sheffield, 3a Clarkehouse Road, S10 2HQ, Sheffield, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, Barley House, University of Bristol, Oakfield Grove, Clifton, BS8 2BN, Bristol, UK
| | - Katrina d'Apice
- Population Health Sciences, Bristol Medical School, Barley House, University of Bristol, Oakfield Grove, Clifton, BS8 2BN, Bristol, UK
| | - Patricia N Albers
- Population Health Sciences, Bristol Medical School, Barley House, University of Bristol, Oakfield Grove, Clifton, BS8 2BN, Bristol, UK
| | - Clare Mills
- Public Health, Floor 4, Halford Wing, City Hall, 115 Charles Street, LE1 1FZ, Leicester City Council, UK
| | - Matthew Curtis
- Public Health, Floor 4, Halford Wing, City Hall, 115 Charles Street, LE1 1FZ, Leicester City Council, UK
| | - Lisa Hopkins
- Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicestershire, LE4 8PQ, Leicester, UK
| | - Sarah Tebbett
- Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicestershire, LE4 8PQ, Leicester, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, Barley House, University of Bristol, Oakfield Grove, Clifton, BS8 2BN, Bristol, UK
| | - Frank De Vocht
- Population Health Sciences, Bristol Medical School, Barley House, University of Bristol, Oakfield Grove, Clifton, BS8 2BN, Bristol, UK
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12
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Adolescent depression screening in primary care: Who is screened and who is at risk? J Affect Disord 2022; 299:318-325. [PMID: 34910961 DOI: 10.1016/j.jad.2021.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older. METHODS Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression. RESULTS A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races. LIMITATIONS Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted. CONCLUSIONS Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.
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Husky MM, Bitfoi A, Carta MG, Goelitz D, Koç C, Lesinskiene S, Mihova Z, Otten R, Kovess-Masfety V. Bullying involvement and suicidal ideation in elementary school children across Europe. J Affect Disord 2022; 299:281-286. [PMID: 34915081 DOI: 10.1016/j.jad.2021.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bullying involvement is associated with suicidal ideation among adolescents, yet there are no studies examining this issue among younger children. METHODS The School Children Mental Health in Europe study was conducted in seven countries in 2010 using similar methods to collect cross-sectional data from children, parents, and teachers. Suicidal ideation and thoughts of death were assessed using the Dominic Interactive among children. Parent and teacher reports were used to determine bullying involvement. The sample comprised n = 5,183 children ages 6 to 11 identified as bullies (n = 740, 14.3%), victims (n = 945, 18.2%), bully-victims (n = 984, 18.2%) and not involved in bullying (n = 2,514, 48.5%). Multivariate logistic regressions were used to assess the association of bullying involvement with suicidal ideation and thoughts of death. RESULTS Suicidal ideation was reported by 13.3% of those not involved in bullying, 17.1% of victims, 19.6% of bullies and 24.4% of bully-victims. Similarly, thoughts of death were reported by 19.0% of victims, 24.3% of bullies, and 25.0% of bully-victims. Children identified as being involved were more likely than those not involved to report suicidal ideation in bivariate analyses. When controlling for psychopathology and for maternal distress among other factors, the association remained significant for bullies (AOR=1.30, 95%CI=1.01-1.66), bully-victims (AOR=1.54, 95%CI=1.22-1.94), but not for victims (AOR=1.02, 95%CI=0.80-1.30). LIMITATIONS The study is cross-sectional. The assessment of bullying may have underestimated victimization. CONCLUSIONS The association of bullying involvement and child suicidal ideation is present among elementary school children across Europe, using multiple informants to avoid shared variance biases, and adjusting for key factors.
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Affiliation(s)
- Mathilde M Husky
- Laboratoire de psychologie EA4139, Université de Bordeaux, Bordeaux, France.
| | - Adina Bitfoi
- The Romanian League for Mental Health, Bucharest, Romania
| | - Mauro Giovanni Carta
- Centro di Psichiatria di Consulenza e Psicosomatica Azienda Ospedaliero, Universitaria di Cagliari, Italy
| | - Dietmar Goelitz
- Department of Humanities, Social Sciences and Theology, Friedrich-Alexander-University, Erlangen-Nuernberg, Germany
| | - Ceren Koç
- Yeniden Health and Education Society, Istanbul, Turkey
| | - Sigita Lesinskiene
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius University, Vilnius, Lithuania
| | | | - Roy Otten
- Pluryn, Research & Development, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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Crandal BR, Aguinaldo LD, Carter C, Billman GF, Sanderson K, Kuelbs C. Opportunities for Early Identification: Implementing Universal Depression Screening with a Pathway to Suicide Risk Screening in a Pediatric Health Care System. J Pediatr 2022; 241:29-35.e1. [PMID: 34695448 PMCID: PMC8792242 DOI: 10.1016/j.jpeds.2021.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the implementation process and assess results of a large-scale universal depression screening program with pathways to suicide risk screening in a pediatric integrated delivery network. STUDY DESIGN This retrospective study analyzes depression and suicide risk screening data for 95 613 patients ages 12-17 years. RESULTS Of the 95 613 adolescent patients who were screened for depression, 2.4% (2266) screened positive for risk for moderate-severe depression (>10 Patient Health Questionnaire; 9-item version) and 4.1% (3942) endorsed elevated suicide risk (≥1 Columbia Suicide Severity Rating Scale). Overall, 51% of screened patients who present with a primary psychiatric concern screened positive for elevated risk of suicide (2132). Two percent of screened patients who presented with a primary medical concern screened positive for elevated risk of suicide. Nearly one-half (45.9%) of all elevated suicide risk screenings were from patients with a primary medical concern. CONCLUSIONS A large-scale universal depression screening program with a pathway to identify elevated suicide risk was implemented in a pediatric health care system using the Patient Health Questionnaire and the Columbia Suicide Severity Rating Scale. This screening program identified youth with moderate-severe depression and elevated risk for suicide with and without presenting psychiatric concerns across service settings.
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Affiliation(s)
| | | | | | | | | | - Cynthia Kuelbs
- Rady Children's Hospital, San Diego, San Diego, CA; Department of Pediatrics, University of San Diego, La Jolla, CA
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The Link Between Depressive Symptoms and Vaping Nicotine in U.S. Adolescents, 2017-2019. J Adolesc Health 2022; 70:133-139. [PMID: 34384705 DOI: 10.1016/j.jadohealth.2021.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/01/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE While there is a well-established association between depression and cigarette use, the mental health sequelae of vaping nicotine remain unclear. This study examined whether adolescents with depressive symptoms had higher odds of vaping nicotine than others, and how this association differed when examining vaping with cigarette use, vaping without cigarette use, and cigarette use alone. METHODS Using 2017-2019 Monitoring the Future data, we examined U.S. adolescents in the eighth, 10th and 12th grades surveyed in schools across the contiguous states. Depressive symptoms were measured by using questions around negative affect and hopelessness. The outcome included vaping with cigarette use; vaping without cigarette use; cigarette use alone; and neither. Control covariates included sex, race, highest level of parental education, and average grades. RESULTS The sample included 32,636 adolescents. Depressive symptoms were positively associated with comorbid vaping and cigarette use across all grades (eighth graders: adjusted odds ratio [aOR] = 3.52 [95% confidence interval (CI): 1.94-6.39]; 10th graders: aOR = 2.26 [95% CI: 1.51-3.38]; 12th graders: aOR = 1.81 [95% CI: 1.05-3.12]); vaping without cigarette use among eighth graders (eighth graders: aOR = 2.01 [95% CI: 1.46-2.77]; 10th graders: aOR = 1.20 [95% CI: .97-1.49]; 12th graders: aOR = 1.20 [95% CI: .84-1.70]); and cigarette use alone among eighth and 10th graders (eighth graders: aOR = 2.91 [95% CI: 1.50-5.62]; 10th graders: aOR = 2.29 [95% CI: 1.35-3.88]; 12th graders: aOR = 1.73 [95% CI: .83-3.61]). CONCLUSIONS Eighth grade adolescents with depressive symptoms have increased odds of vaping nicotine with and without cigarette use. As vaping prevalence increases, clinician assessment of adolescent vaping should concomitantly acknowledge potential mental health correlates. Vaping may be a marker for a broader constellation of adolescent health concerns, including mental health.
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Anand P, Bhurji N, Williams N, Desai N. Comparison of PHQ-9 and PHQ-2 as Screening Tools for Depression and School Related Stress in Inner City Adolescents. J Prim Care Community Health 2021; 12:21501327211053750. [PMID: 34905994 PMCID: PMC8679043 DOI: 10.1177/21501327211053750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Major depressive disorder is associated with significant morbidity and
mortality in adolescents. Suicide is one of the leading causes of mortality
between 15 and 19 years. Both AAP and USPSTF recommend routine depression
screening of adolescents. Patient Health Questionnaire-2 (PHQ-2) and Patient
Health Questionnaire-9 (PHQ-9) are widely used in primary care practice,
however, PHQ-2 does not screen for suicidality. School-related factors are
known to affect adolescent mental health. Purpose To compare PHQ-2 and PHQ-9 for depression screening in adolescents, with
respect to age, gender, chronic illness over the course of 9 months. Methods As a QI initiative, we compared screening results in our inner-city pediatric
practice using PHQ-2 and PHQ-9 from Jun’18 to Feb’19. EMR of 2364 patients
12 to 21 years were reviewed. We considered the PHQ-2 score of ≥2 and PHQ-9
of ≥10 as positive. Pre-existing chronic medical and mental illnesses were
noted. Results Of these 61.5% of patients were females, 95% were Black/Hispanic, and 96%
were insured by Medicaid. About 10.6% of PHQ-9 tests were positive whereas
7.4% PHQ2 were positive. Logistic regression was performed to ascertain the
effects of age, gender, and chronic illness. Females were more likely to
have a positive screen, as were patients with chronic illness. Age had no
effect on the outcome. The screening yield for both tests was comparable in
the summer months. PHQ9 yield increased while schools were in session while
PHQ 2 remained stable. Conclusion PHQ9 is superior as a screening test compared to PHQ2. Repeat screening
should be targeted toward patients with chronic medical conditions and/or
mental health diagnoses. PHQ9 may be better at screening for school-related
stress.
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Affiliation(s)
- Paridhi Anand
- NYC Health+Hospitals/Kings County, Brooklyn, NY, USA
| | | | | | - Ninad Desai
- NYC Health+Hospitals/Kings County, Brooklyn, NY, USA
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Radovic A, Anderson N, Hamm M, George-Milford B, Fascetti C, Engster S, Lindhiem O. Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study. JMIR Ment Health 2021; 8:e26035. [PMID: 34524090 PMCID: PMC8482166 DOI: 10.2196/26035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/27/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. OBJECTIVE This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. METHODS We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nathan Anderson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan Hamm
- Center for Research on Healthcare's Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Carrie Fascetti
- Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stacey Engster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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18
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Jones LM, Nolte K, O'Brien AJ, Trumbell JM, Mitchell KJ. Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings. J Pediatr Nurs 2021; 59:37-44. [PMID: 33460878 DOI: 10.1016/j.pedn.2020.12.014] [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: 10/21/2019] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks. DESIGN AND METHODS Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview. RESULTS Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health. CONCLUSIONS Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks. PRACTICE IMPLICATIONS Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.
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Affiliation(s)
- Lisa M Jones
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
| | - Kerry Nolte
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Alyssa J O'Brien
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Jill M Trumbell
- Human Development & Family Studies, University of New Hampshire, Durham, NH, United States of America.
| | - Kimberly J Mitchell
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
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Hammersen J, Tittel SR, Warncke K, Fritsch M, Placzek K, Pacaud D, Karges B, Woelfle J, Holl RW. Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative. Pediatr Diabetes 2021; 22:455-462. [PMID: 33533571 DOI: 10.1111/pedi.13185] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time-lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS In a population-based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow-up were retrieved from the "Diabetes Prospective Follow-up" (DPV) multi-center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. RESULTS Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3-4.6] per 100 patient-years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9-19.5] vs. 2.8 [2.7-3.1] per 100 patient-years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6-11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6-3.1]; p < 0.001). CONCLUSIONS Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow-up after each episode.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Kerstin Placzek
- Pediatric and Adolescent Medicine, University Hospital, Martin-Luther University, Halle, Germany
| | - Danièle Pacaud
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatric Diabetes and Endocrinology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Beate Karges
- Division of Endocrinology and Diabetology, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Pediatrics, Bethlehem Hospital Stolberg, Stolberg, Germany
| | - Joachim Woelfle
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Depression Screening in Pediatric Inflammatory Bowel Disease Clinics: Recommendations and a Toolkit for Implementation. J Pediatr Gastroenterol Nutr 2020; 70:42-47. [PMID: 31568153 PMCID: PMC7187415 DOI: 10.1097/mpg.0000000000002499] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Rates of youth depression are increasing, and approximately 75% of adolescents with depression go unrecognized. Research in pediatric IBD documents increased depression risk, with rates up to 25%, as well as worse adherence and treatment outcomes associated with depressive symptoms. Evidence-based psychological interventions improve the physical and emotional health of these patients, highlighting the importance of detection and treatment. Psychosocial screening has been shown to increase the accurate identification of psychosocial problems and facilitate timely psychosocial intervention. The objective of this article is to establish clinical guidelines for depression screening in youth diagnosed with IBD and to provide resources for implementation. METHODS The psychosocial screening task force group constituted of psychologists and social workers in the ImproveCareNow (ICN) learning health system reviewed research and clinical guidelines in other fields, and consulted with physicians, nurses, other psychosocial professionals, patients with IBD, and parents of children with IBD in ICN. RESULTS/CONCLUSIONS It is recommended that adolescents with IBD ages 12 and older be screened for depression annually. Additional practical recommendations for implementation, triage, and treatment within the pediatric gastroenterology clinic are also provided.
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Abstract
PURPOSE OF REVIEW To review the clinical practice guideline landscape for depression screening in pediatric primary care and to identify current gaps in knowledge. RECENT FINDINGS Various organizations have recommendations that support screening for depression in pediatric primary care, although some differ based on the age of the child. To date, guidelines have been made based on indirect evidence of efficacy. For example, indirect evidence shows that several screening tools exist for use in primary care, and various primary care-administered or referred treatments for childhood depression have some evidence of efficacy (particularly among adolescents). In addition to determining the applicability of this evidence to younger children, more research is needed on the direct net benefits of screening and to identify factors that facilitate its effective implementation. Indirect evidence supports the benefits of screening for depression in pediatric primary care; most organizations that publish screening guidelines recommend its use.
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Zuckerbrot RA, Cheung A, Jensen PS, Stein RE, Laraque D, Levitt A, Birmaher B, Campo J, Clarke G, Emslie G, Kaufman M, Kelleher KJ, Kutcher S, Malus M, Sacks D, Waslick B, Sarvet B. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics 2018; 141:peds.2017-4081. [PMID: 29483200 DOI: 10.1542/peds.2017-4081] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To update clinical practice guidelines to assist primary care (PC) clinicians in the management of adolescent depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of adolescent depression in PC settings. METHODS By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of adolescents with depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of depression in youth who are at high risk; (4) systematic assessment procedures by using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS This part of the guidelines is intended to assist PC clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for depression management in adolescents. Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.
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Affiliation(s)
- Rachel A. Zuckerbrot
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, and New York State Psychiatric Institute, New York, New York
| | | | - Peter S. Jensen
- University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Ruth E.K. Stein
- Albert Einstein College of Medicine, Bronx, New York, New York; and
| | - Danielle Laraque
- State University of New York Upstate Medical University, Syracuse, New York
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Bhatta S, Champion JD, Young C, Loika E. Outcomes of Depression Screening Among Adolescents Accessing School-based Pediatric Primary Care Clinic Services. J Pediatr Nurs 2018; 38:8-14. [PMID: 29167086 DOI: 10.1016/j.pedn.2017.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Implementation of routine Patient Health Questionnaires (PHQ-9) screening among adolescents aged 12-18year, accessing school-based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD). DESIGN AND METHODS Retrospective chart review (N=256 cases) documented PHQ-9 depression screening outcomes among adolescents accessing school-based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods. RESULTS Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ-9 depression screening was identified for 56.3% (n=144) of charts with scores ≥10 for 12.5% (n=18) among those screened. Mental health referrals were made for 83.3% (n=15) with PHQ-9 scores ≥10. Dysthymia related concerns were reported among 20.1% (n=29) of which 55.2% (n=16) received mental health referrals. Female adolescents reported more sleep problems (χ2=9.174, p=0.002) and tiredness (χ2=6.165, p=0.013) than males. The 15-18year age group (χ2=5.443, p=0.020) was more likely to experience sleep problem and low self-esteem than 12-14year age group (χ2=5.143, p=0.023). CONCLUSION Implementation of PHQ-9 depression screening protocol identified MDD among adolescent accessing pediatric school-based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents. PRACTICE IMPLICATIONS MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school-based clinics.
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Affiliation(s)
- Sarmila Bhatta
- Family Nurse Practitioner, School of Nursing, The University of Texas at Austin, USA.
| | - Jane Dimmitt Champion
- Lee and Joseph D. Jamail Endowed Professorship in Nursing, School of Nursing, The University of Texas at Austin, Austin, USA.
| | - Cara Young
- School of Nursing, The University of Texas at Austin, Austin, USA.
| | - Elizabeth Loika
- Clinical Associate Professor, School of Nursing, The University of Texas at Austin, Austin, USA.
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A Little Effort Can Withstand the Hardship: Fielding an Internet-Based Intervention to Prevent Depression among Urban Racial/Ethnic Minority Adolescents in a Primary Care Setting. J Natl Med Assoc 2017; 110:130-142. [PMID: 29580446 DOI: 10.1016/j.jnma.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/18/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study explored the implementation of Chicago Urban Resiliency Building (CURB), a randomized clinical trial designed as an Internet-based primary care depression prevention intervention for urban African American and Latino adolescents. METHODS We utilized a mixed methods analysis to explore four aims. First, we estimated the percent of at-risk adolescents that were successfully screened. Second, we examined clinic site factors and performance. Third, primary care providers (n = 10) and clinic staff (n = 18) were surveyed to assess their knowledge and attitudes about the intervention. Fourth, clinic staff (nursing and medical assistant) interviews were analyzed using thematic analysis to gather perspectives of the implementation process. RESULTS We found that the estimated percent of at-risk adolescents who were successfully screened in each clinic varied widely between clinics with a mean of 14.48%. Daily clinic communication was suggestive of greater successful screening. Feasibility of screening was high for both primary care providers and clinic staff. Clinic staff exit interviews indicated the presence of community barriers that inhibited successful implementation of the intervention. CONCLUSION This study shares the challenges and successes for depression screening and implementing Internet-based mental health interventions for urban racial/ethnic minority adolescents in primary care settings.
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Arcaro J, Summerhurst C, Vingilis E, Wammes M, Osuch E. Presenting concerns of emerging adults seeking treatment at an early intervention outpatient mood and anxiety program. PSYCHOL HEALTH MED 2016; 22:978-986. [PMID: 27781492 DOI: 10.1080/13548506.2016.1248449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined presenting concerns and characteristics of emerging adults (EAs) seeking treatment at an early intervention program for mood and anxiety disorders to better understand presenting concerns when treatment is needed. During an intake assessment conducted by a social worker or clinical psychologist, participants (N = 548; 62% female, 38% male) reported their top three current life concerns, which were analyzed qualitatively using thematic analysis. Participants completed a battery of questionnaires assessing demographic information, symptomatology, and daily functioning. Females presented with significantly higher levels of anxiety, and both females and younger individuals (age 16-18) presented with significantly higher levels of depression compared to males and older individuals (age 19-26), respectively. The two most commonly reported presenting concerns were problems in interpersonal relationships and academics, and females were more likely to report academic concerns than males. The majority of participants reported seeking help for a wide range of problems commonly faced by EAs (83.7%), and participants rarely expressed concerns about particular symptoms of mood and/or anxiety disorders (16.3%). EAs and those supporting EAs may benefit from learning when psychosocial concerns are indicative of mental health challenges warranting professional attention.
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Affiliation(s)
- Justin Arcaro
- a Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, and London Health Sciences Centre , London , Canada
| | - Carolyn Summerhurst
- a Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, and London Health Sciences Centre , London , Canada
| | - Evelyn Vingilis
- b Department of Family Medicine, Schulich School of Medicine and Dentistry, The Western Centre for Public Health and Family Medicine, University of Western Ontario , London , Canada
| | - Michael Wammes
- a Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, and London Health Sciences Centre , London , Canada
| | - Elizabeth Osuch
- a Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, and London Health Sciences Centre , London , Canada
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Prochaska JD, Le VD, Baillargeon J, Temple JR. Utilization of Professional Mental Health Services Related to Population-Level Screening for Anxiety, Depression, and Post-traumatic Stress Disorder Among Public High School Students. Community Ment Health J 2016; 52:691-700. [PMID: 26733335 PMCID: PMC4930415 DOI: 10.1007/s10597-015-9968-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/11/2015] [Indexed: 11/24/2022]
Abstract
This study examines results from three mental health screening measures in a cohort of adolescent public school students in seven public schools in Southeast Texas affiliated with the Dating it Safe study. We estimated the odds of receiving professional mental health treatment in the previous year given results from different mental health screening batteries: the CES-D 10 battery for depression screening, the Screen for Child Anxiety Related Disorders, and the Primary Care Posttraumatic Stress Disorder screen. Overall, students with higher scores on screening instruments for depression, posttraumatic stress disorder, and combinations of screening instruments were more likely to have sought past-year professional mental health treatment than non-symptomatic youth. However, the proportion of students screening positive and receiving professional treatment was low, ranging from 11 to 16 %. This study emphasizes the need for broader evaluation of population-based mental health screening among adolescents.
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Affiliation(s)
- John D Prochaska
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, 77555-1153, USA.
| | - Vi Donna Le
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, 77555-1153, USA
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, 77555-1153, USA
| | - Jeff R Temple
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
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Humphrey N, Wigelsworth M. Making the case for universal school-based mental health screening. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2016. [DOI: 10.1080/13632752.2015.1120051] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hinton R, Kavanagh DJ, Barclay L, Chenhall R, Nagel T. Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: a qualitative study. BMJ Open 2015; 5:e007938. [PMID: 26316649 PMCID: PMC4554908 DOI: 10.1136/bmjopen-2015-007938] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. DESIGN A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis SETTING 2 remote communities in the Northern Territory. PARTICIPANTS Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. RESULTS The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. CONCLUSIONS Successful early intervention for well-being concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.
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Affiliation(s)
- Rachael Hinton
- Healing and Resilience, Menzies School of Health Research, Darwin, Australia
| | - David J Kavanagh
- Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
| | - Lesley Barclay
- University Centre for Rural Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Richard Chenhall
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Tricia Nagel
- Healing and Resilience, Menzies School of Health Research, Darwin, Australia
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29
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Perelini F, Blair N, Wilson N, Farrell A, Aitken A. Family acceptability of school-based echocardiographic screening for rheumatic heart disease in a high-risk population in New Zealand. J Paediatr Child Health 2015; 51:682-8. [PMID: 25756837 DOI: 10.1111/jpc.12829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/30/2022]
Abstract
AIM Echocardiographic screening for rheumatic heart disease has been piloted in high-risk areas in New Zealand and internationally, and fulfils most of the criteria for a targeted screening programme. The question of acceptability of rheumatic heart disease screening has not been assessed, and the aim of our study was to assess parental acceptability of a school-based echocardiographic screening programme in a high-risk population in New Zealand. METHODS A post-screening questionnaire was developed to survey parents of children who underwent echocardiographic screening. The families of 34 children with abnormal scan results and a sample of 80 children with normal scan results were surveyed by phone within 4 months of screening. RESULTS Positive results were seen in all survey questions in both normal and abnormal scan groups. All families were supportive of an ongoing screening programme. Of children with abnormal results, 62% of their parents reported that they would treat their child differently; however, all responses were positive health-promoting outcomes. CONCLUSION The study showed strong positive support for school-based echocardiographic screening by a community with high acute rheumatic fever incidence. The study did not detect any short-term negative effects in those with abnormal results. The survey result shows family and community support for the establishment of echocardiographic screening programmes in high acute rheumatic fever areas provided there is adequate infrastructural support.
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Affiliation(s)
- Fiona Perelini
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nikki Blair
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nigel Wilson
- Green Lane Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Alan Farrell
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Andrew Aitken
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
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Gadomski AM, Fothergill KE, Larson S, Wissow LS, Winegrad H, Nagykaldi ZJ, Olson AL, Roter DL. Integrating mental health into adolescent annual visits: impact of previsit comprehensive screening on within-visit processes. J Adolesc Health 2015; 56:267-73. [PMID: 25586231 PMCID: PMC4339519 DOI: 10.1016/j.jadohealth.2014.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate how a comprehensive, computerized, self-administered adolescent screener, the DartScreen, affects within-visit patient-doctor interactions such as data gathering, advice giving, counseling, and discussion of mental health issues. METHODS Patient-doctor interaction was compared between visits without screening and those with the DartScreen completed before the visit. Teens, aged 15-19 years scheduled for an annual visit, were recruited at one urban and one rural pediatric primary care clinic. The doctor acted as his/her own control, first using his/her usual routine for five to six adolescent annual visits. Then, the DartScreen was introduced for five visits where at the beginning of the visit, the doctor received a summary report of the screening results. All visits were audio recorded and analyzed using the Roter interaction analysis system. Doctor and teen dialogue and topics discussed were compared between the two groups. RESULTS Seven midcareer doctors and 72 adolescents participated; 37 visits without DartScreen and 35 with DartScreen were audio recorded. The Roter interaction analysis system defined medically related data gathering (mean, 36.8 vs. 32.7 statements; p = .03) and counseling (mean, 36.8 vs. 32.7 statements; p = .01) decreased with DartScreen; however, doctor responsiveness and engagement improved with DartScreen (mean, 4.8 vs. 5.1 statements; p = .00). Teens completing the DartScreen offered more psychosocial information (mean, 18.5 vs. 10.6 statements; p = .01), and mental health was discussed more after the DartScreen (mean, 93.7 vs. 43.5 statements; p = .03). Discussion of somatic and substance abuse topics did not change. Doctors reported that screening improved visit organization and efficiency. CONCLUSIONS Use of the screener increased discussion of mental health but not at the expense of other adolescent health topics.
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Affiliation(s)
- Anne M Gadomski
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York.
| | - Kate E Fothergill
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Larson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence S Wissow
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Heather Winegrad
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Zsolt J Nagykaldi
- Department of Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ardis L Olson
- Department of Pediatrics, Dartmouth Medical School, Lebanon, New Hampshire
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Jonovich SJ, Alpert-Gillis LJ. Impact of pediatric mental health screening on clinical discussion and referral for services. Clin Pediatr (Phila) 2014; 53:364-71. [PMID: 24302536 DOI: 10.1177/0009922813511146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study discusses the impact of mental health screening in pediatric primary care on the management of mental health concerns. METHODS Youth aged 11 years and their parents completed the Pediatric Symptom Checklist and chart reviews were used to gather information about discussion of mental health concerns and connection with mental health services. The study design was a post-intervention study with a concurrent comparison group of youth aged 12 years who were not offered a screening. The χ(2) or Fisher's exact tests and logistic regression were used to compare groups on outcome variables. RESULTS Parents who completed a mental health screening for their child were more likely to be referred and attend mental health services, attend a psychiatrist appointment, and discuss their concerns with the primary care provider compared with the comparison group. CONCLUSIONS Screening by parents improves detection of problems and fosters conversations with providers and subsequent connection with services.
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Fuhrmann P, Equit M, Schmidt K, von Gontard A. Prevalence of depressive symptoms and associated developmental disorders in preschool children: a population-based study. Eur Child Adolesc Psychiatry 2014; 23:219-24. [PMID: 23839066 DOI: 10.1007/s00787-013-0452-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/27/2013] [Indexed: 12/27/2022]
Abstract
Depression is an incapacitating disorder, which is often overlooked in preschool children. The aim of this study was to analyse the prevalence of depressive symptoms and co-occurring risk factors in a large, population-based sample of preschool children. All 653 children (of a total of 731) in a defined geographical area were assessed during the school-entry exam by community care paediatricians. In addition to clinical appraisal, parents filled out the Preschool Feelings Checklist, a 16-item screening instrument with good psychometric properties. The mean age was 6.2 years (range 5.0-7.6 years) and the sample included 344 boys and 305 girls. The prevalence of depressive symptoms of clinical relevance (total score ≥3) was 5.7% (37). There were no differences between boys and girls, and between younger (<6 years) and older (>6 years) children. Depressive symptoms were associated with parental separation and comorbid behavioural problems, but especially with developmental motor and speech problems and disorders. Migration to Germany had no influence. Depressive symptoms are common in preschool children and associated with developmental problems. Depression should be considered in children with speech and motor problems who are at special risk. Early detection and treatment are recommended.
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Affiliation(s)
- Pia Fuhrmann
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, 66421, Germany
| | - Monika Equit
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, 66421, Germany
| | - Karin Schmidt
- Institute for Community Health, Kreis St. Wendel, St. Wendel, Germany
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, 66421, Germany.
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Romano-Clarke G, Tang MH, Xerras DC, Egan HS, Pasinski RC, Kamin HS, McCarthy AE, Newman J, Jellinek MS, Murphy JM. Have rates of behavioral health assessment and treatment increased for Massachusetts children since the Rosie D. decision? A report from two primary care practices. Clin Pediatr (Phila) 2014; 53:243-9. [PMID: 24220574 DOI: 10.1177/0009922813507993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following a court decision (Rosie D. v. Romney), the Medicaid program in Massachusetts launched the statewide Children's Behavioral Health Initiative in 2008 to increase the recognition and treatment of behavioral health problems in pediatrics. We reviewed billing data (n = 64,194) and electronic medical records (n = 600) for well child visits in pediatrics in 2 practices to examine rates of behavioral health screening, problem identification, and treatment among children seen during the year before and 2 years after the program's implementation. According to electronic medical records, the percentage of well child visits that included any form of behavioral health assessment increased significantly during the first 2 years of the program, and pediatricians significantly increased their use of standardized screens. According to billing data, behavioral health treatment increased significantly. These findings suggest that behavioral health screening and treatment have increased following the Rosie D. decision.
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Salerno J, Barnhart S. Evaluation of the RAAPS Risk Screening Tool for Use in Detecting Adolescents With Depression. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 27:20-5. [DOI: 10.1111/jcap.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics 2014; 133:114-22. [PMID: 24298010 PMCID: PMC3876179 DOI: 10.1542/peds.2013-0927] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2013] [Indexed: 11/24/2022] Open
Abstract
Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents' engagement in mental health treatment.
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Affiliation(s)
- Stacy Hodgkinson
- Diana L. and Stephen A. Goldberg Center for Community Pediatric Health, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010.
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37
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Eisen JC, Marko-Holguin M, Fogel J, Cardenas A, Bahn M, Bradford N, Fagan B, Wiedmann P, Van Voorhees BW. Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives. Prim Care Companion CNS Disord 2013; 15:10m01065. [PMID: 24800110 DOI: 10.4088/pcc.10m01065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 10/02/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. METHOD The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). RESULTS While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. CONCLUSION Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912.
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Affiliation(s)
- Jeffrey C Eisen
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Monika Marko-Holguin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Joshua Fogel
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Alonso Cardenas
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - My Bahn
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Nathan Bradford
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Blake Fagan
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Peggy Wiedmann
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
| | - Benjamin W Van Voorhees
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Marko-Holguin and Dr Van Voorhees); Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Eisen); Department of Finance and Business Management, Brooklyn College of the City University of New York, Brooklyn (Dr Fogel); Department of Medicine, University of Chicago, Chicago, Illinois (Mr Cardenas and Dr Bahn); Department of Family Medicine, Anderson Area Medical Center, Anderson, South Carolina (Dr Bradford); Department of Family Medicine, University of North Carolina-Chapel Hill at the Mountain Area Health Education Center, Asheville, North Carolina (Dr Fagan); and Advocate Healthcare, Chicago, Illinois (Dr Wiedmann)
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Corathers SD, Kichler J, Jones NHY, Houchen A, Jolly M, Morwessel N, Crawford P, Dolan LM, Hood KK. Improving depression screening for adolescents with type 1 diabetes. Pediatrics 2013; 132:e1395-402. [PMID: 24127480 DOI: 10.1542/peds.2013-0681] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children's Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥ 16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population. CONCLUSIONS Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions.
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Affiliation(s)
- Sarah D Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC7012, Cincinnati, OH 45219.
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Wissow LS, Brown J, Fothergill KE, Gadomski A, Hacker K, Salmon P, Zelkowitz R. Universal mental health screening in pediatric primary care: a systematic review. J Am Acad Child Adolesc Psychiatry 2013; 52:1134-1147.e23. [PMID: 24157388 PMCID: PMC3942871 DOI: 10.1016/j.jaac.2013.08.013] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Universal mental health screening in pediatric primary care is recommended, but studies report slow uptake and low rates of patient follow-through after referral to specialized services. This review examined possible explanations related to the process of screening, focusing on how parents and youth are engaged, and how providers evaluate and use screening results. METHOD A narrative synthesis was developed after a systematic review of 3 databases (plus follow-up of citations, expert recommendations, and checks for multiple publications about the same study). Searching identified 1,188 titles, and of these, 186 full-text articles were reviewed. Two authors extracted data from 45 articles meeting inclusion criteria. RESULTS Published studies report few details about how mental health screens were administered, including how clinicians explain their purpose or confidentiality, or whether help was provided for language, literacy, or disability problems. Although they were not addressed directly in the studies reviewed, uptake and detection rates appeared to vary with means of administration. Screening framed as universal, confidential, and intended to optimize attention to patient concerns increased acceptability. Studies said little about how providers were taught to explore screen results. Screening increased referrals, but many still followed negative screens, in some cases because of parent concerns apparently not reflected by screen results but possibly stemming from screen-prompted discussions. CONCLUSIONS Little research has addressed the process of engaging patients in mental health screening in pediatric primary care or how clinicians can best use screening results. The literature does offer suggestions for better clinical practice and research that may lead to improvements in uptake and outcome.
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Fox HB, McManus MA, Irwin CE, Kelleher KJ, Peake K. A research agenda for adolescent-centered primary care in the United States. J Adolesc Health 2013; 53:307-10. [PMID: 23972582 DOI: 10.1016/j.jadohealth.2013.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/24/2013] [Accepted: 06/27/2013] [Indexed: 01/23/2023]
Abstract
Little attention has been given to how primary care can be transformed to better meet the needs of adolescents. To help generate the evidence needed, The National Alliance to Advance Adolescent Health convened an invitational conference in 2012 in Washington, DC. Participants from various disciplines identified a set of prioritized recommendations pertaining to 3 topics: increasing adolescent and parent engagement and self-care management; improving preventive care and identifying conditions early; and integrating physical, behavioral, and reproductive health services. This commentary includes the top three recommendations for each topic area and concludes with a brief examination of federal and private funding prospects.
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Abstract
Early detection of mental health problems in school-age children offers the opportunity for prompt referral to treatment which is critical to their success in school. School nurses are in a key position to screen for mental health issues in the school setting. This article discusses how school nurses began a new initiative to use two validated screening tools, the Patient Health Questionnaire–9 item for detecting depression and the 5-item Screen for Child Anxiety Related Emotional Disorders for detecting anxiety in middle school/high school-aged children in selected urban schools. Students having positive screens were referred to the multidisciplinary school-based Student Assistance Program team for further evaluation and referral. These screens improved the identification and referral for treatment of children suffering from anxiety and/or depression by expediting the connection to services.
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Youths' health-related social problems: concerns often overlooked during the medical visit. J Adolesc Health 2013; 53:265-71. [PMID: 23643339 DOI: 10.1016/j.jadohealth.2013.02.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/25/2013] [Accepted: 02/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objectives of this study were to (1) measure the prevalence of health-related social problems among adolescent and young adult primary care patients; (2) estimate previous screening and referral experiences; and (3) examine participant attitudes toward screening and referral. METHODS Data were collected as part of a cross-sectional study conducted in an urban young adult clinic. Patients aged 15 to 25 years completed a computerized questionnaire screening for health-related social problems in nine social domains. In addition, participants answered questions about their previous screening experiences, need for referrals, and their experience using the system. RESULTS Seventy-six percent (304/401) of youth screened positive for at least one major problem, including healthcare access (37%), housing (34%), and food security (29%). Forty-seven percent (190/401) experienced major problems in two or more social domains. The prevalence of screening in the past year for each domain averaged 26%; 3% were screened in all nine domains in the previous 12 months and 33% were not screened in any domain. Overall, 75% needed a referral within the previous year, and 42% identified at least one unmet referral need. The majority (84%) of participants reported that it was acceptable to screen for these problems. CONCLUSION Prevalence of health-related social problems among youth is high. The majority needed at least one referral for a social need in the previous year. Primary care physicians would benefit from improved systems for screening and referral of health-related social problems in order to create a comprehensive medical home for their patients.
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Toledano P, Sarbu N, Espinosa G, Bargalló N, Cervera R. Neuropsychiatric systemic lupus erythematosus: magnetic resonance imaging findings and correlation with clinical and immunological features. Autoimmun Rev 2013; 12:1166-70. [PMID: 23851139 DOI: 10.1016/j.autrev.2013.07.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
Neuropsychiatric (NP) syndromes are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aims of this work were to describe the brain abnormalities in a group of SLE patients during their first episode of NP manifestations using a conventional magnetic resonance imaging (MRI) technique and to investigate the possible correlation between these findings and the clinical and immunological characteristics of these patients. We performed an observational retrospective cross-sectional study that included all patients with NP symptoms who underwent MRI at the Hospital Clinic of Barcelona between the years 2003 and 2012 because of suspecting NP syndromes due to SLE (NPSLE). We studied 43 patients in which 11 types of NPSLE were present, being headache the most frequent, followed by cerebrovascular disease, epileptic crises and cranial neuropathy. A statistically significant association was found between myelopathy and low complement (C4) levels (p=0.035) and disease activity measured as SLE Disease Activity Index (SLEDAI) >4 (p=0.00006). Eighteen (41.9%) patients presented MRI abnormalities. We found an association between myelopathy and the presence of inflammatory or mixed (vascular and inflammatory) type lesions (p=0.003). This pattern was also associated with a high SLEDAI score (p=0.002) and low complement (CH50) levels (p=0.032). We found no relationship between MRI changes and age, time of evolution, or the presence of antiphospholipid or anti-dsDNA antibodies. These results suggest that MRI, although it is the imaging modality of choice in the present moment, by itself does not establish or exclude the diagnosis of NPSLE. In addition, the presence of certain disease activity features (SLEDAI and low complement levels) seems to be associated with the presence of an inflammatory pattern on MRI.
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Affiliation(s)
- Pilar Toledano
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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Taliaferro LA, Hetler J, Edwall G, Wright C, Edwards AR, Borowsky IW. Depression screening and management among adolescents in primary care: factors associated with best practice. Clin Pediatr (Phila) 2013; 52:557-67. [PMID: 23572448 DOI: 10.1177/0009922813483874] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. METHODS Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. RESULTS The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. CONCLUSIONS Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.
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Kramer T, Iliffe S, Bye A, Miller L, Gledhill J, Garralda ME. Testing the feasibility of therapeutic identification of depression in young people in British general practice. J Adolesc Health 2013; 52:539-45. [PMID: 23608718 DOI: 10.1016/j.jadohealth.2012.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression in young people attending primary care is common and is associated with impairment and recurrence into adulthood. However, it remains under-recognized. This study evaluated the feasibility of training primary care practitioners (PCPs) in screening and therapeutic identification of adolescent depression, and assessed its effects on practitioner knowledge, attitudes, screening, and management. METHODS We trained PCPs in therapeutic identification of adolescent depression during general practice consultations. To assess changes in knowledge and attitudes, PCPs completed questionnaires before and after training. We ascertained changes in depression screening and identification rates in the 16 weeks before and after training from electronic medical records of young people aged 13-17 years. Post-training management of depression was recorded on a checklist. RESULTS Aspects of practitioner knowledge (of depression prevalence and treatment guidelines) and confidence (regarding depression identification and management) increased significantly (all p < .04). Overall screening rates were enhanced from .7% to 20% after the intervention and depression identification rates from .5% before training to 2% thereafter (29-fold and fourfold increases, respectively). Identification was significantly associated with PCP knowledge of prior mental health problems (Fisher's exact test, p = .026; odds ratio, 4.884 [95% confidence interval, 1.171-20.52]) and of psychosocial stressors (Fisher's exact test, p = .001; odds ratio, 17.45 [95% confidence interval, 2.055-148.2]). CONCLUSIONS The Therapeutic Identification of Depression in Young People program is a feasible approach to improving primary care screening for adolescent depression, with promising evidence of effectiveness. Further evaluation in a randomized trial is required to test practitioner accuracy, clinical impact, and cost benefit.
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Affiliation(s)
- Tami Kramer
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, United Kingdom.
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d'Almeida KW, Pateron D, Kierzek G, Renaud B, Semaille C, de Truchis P, Simon F, Leblanc J, Lert F, Le Vu S, Crémieux AC. Understanding providers' offering and patients' acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France. PLoS One 2013; 8:e62686. [PMID: 23638133 PMCID: PMC3639277 DOI: 10.1371/journal.pone.0062686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/22/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We assessed the EDs’ characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France’s new HIV cases are diagnosed annually. Methods EDs nurses offered testing to all patients 18–64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS’ characteristics collected included structural characteristics (location, type, size), daily workload (patients’ number and severity, length of stay in hours), staff’s participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling. Results Indigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773–0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581–0.667) and decreased over time (OR = 0.978, 95% CI = 0.975–0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623–0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142–2.038). The EDs’ characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate. Conclusion Our findings suggest the need for taking into account EDs’ characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources’ utilization such as HIV targeted screening in the EDs might be privileged.
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McKowen JW, Tompson MC, Brown TA, Asarnow JR. Longitudinal associations between depression and problematic substance use in the Youth Partners in Care study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:669-80. [PMID: 23368836 DOI: 10.1080/15374416.2012.759226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.
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Fothergill K, Gadomski A, Solomon B, Olson A, Gaffney C, dosReis S, Wissow L. Assessing the impact of a web-based comprehensive somatic and mental health screening tool in pediatric primary care. Acad Pediatr 2013; 13:340-7. [PMID: 23830020 PMCID: PMC3767279 DOI: 10.1016/j.acap.2013.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. METHODS A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed. RESULTS A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs. CONCLUSIONS A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns.
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Affiliation(s)
- Kate Fothergill
- Assistant Scientist, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #729, Baltimore, MD 21205, Ph: 202-262-7070; Fax: 410-955-7241
| | - Anne Gadomski
- Attending Pediatrician, Research Scientist, Bassett Medical Center, Research Institute, One Atwell Road, Cooperstown, NY 13326
| | - Barry Solomon
- Associate Professor of Pediatrics, Medical Director, Harriet Lane Clinic, Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 2074, Baltimore, MD 21287
| | - Ardis Olson
- Professor of Pediatrics and of Community and Family Medicine, Dartmouth Medical School, Director, Clinicians Enhancing Child Health, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 05756-0001
| | - Cecelia Gaffney
- CCG Health Communications, LLC, 302 Bauman Ave. Pittsburgh PA 15227
| | - Susan dosReis
- Associate Professor, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-220, Baltimore, MD 21201
| | - Larry Wissow
- Professor, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703, Baltimore, MD 21287
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Sciascia S, Bertolaccini ML, Baldovino S, Roccatello D, Khamashta MA, Sanna G. Central nervous system involvement in systemic lupus erythematosus: Overview on classification criteria. Autoimmun Rev 2013; 12:426-9. [DOI: 10.1016/j.autrev.2012.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 10/28/2022]
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Healy D, Naqvi S, Meagher D, Cullen W, Dunne C. Primary care support for youth mental health: a preliminary evidence base for Ireland's Mid-West. Ir J Med Sci 2012. [PMID: 23179665 DOI: 10.1007/s11845-012-0868-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mental and substance use disorders are leading causes of morbidity. Prevention/treatment amongst young people are global health priorities. International data have highlighted primary care and general practice as important in addressing these. AIMS Survey of 128 physicians (GPs) in Ireland's Mid-West (Counties Limerick, Clare, North Tipperary) to document the spectrum of youth mental health problems, describe strategies adopted by GPs in dealing with these, identify barriers (perceived by GPs) to effective care of young mental health patients and collate GP proposals for improved care of this cohort. METHODS Self-administered questionnaire on physician and practice demographics, case management and barriers to care in youth mental health. RESULTS Thirty-nine GPs (31 %) responded. Mental health and family conflict represented the most frequent reasons why young people attended GPs. Depression, anxiety, family conflict, suicidal thoughts/behaviour, and attention deficit hyperactivity disorder (ADHD) were the most common issues followed by substance abuse and antisocial behaviours. GP referral practices for young people with mental/substance use disorders varied, with distinctions between actual and preferred management due to insufficient access to dedicated youth services and training. GPs stated need for improved access to existing services (i.e., Psychiatry, counseling/psychology, social/educational interventions). A number of GPs surveyed were located, or provided care, in Limerick's 'Regeneration Areas'. Young people in these areas predominantly attended GPs due to mental/substance use issues and antenatal care, rather than acute or general medical problems. CONCLUSIONS GPs play an important role in meeting youth mental health needs in this region and, in particular, in economically deprived urban areas.
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Affiliation(s)
- D Healy
- Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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