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Kilkelly TJ, Palmer J, Kreashko L. Improving Mental Health Outcomes in Adolescent Patients With Universal Anxiety Screening in an Outpatient Pediatric Primary Care Office: A Quality Improvement Project. J Pediatr Health Care 2023; 37:688-695. [PMID: 37715758 DOI: 10.1016/j.pedhc.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION In the wake of the cultural and mental health consequences that arose since the COVID-19 pandemic, primary care providers must be able to assess and initiate treatment of anxiety disorders in the pediatric population. Only 59% of children with a diagnosable anxiety disorder are identified and receive treatment. This quality improvement project aimed to evaluate the implementation of universal anxiety screening using the General Anxiety Disorder-7 tool in pediatric primary care. METHODS Screening was performed on adolescents (aged 12-18 years) to evaluate the frequency and acceptability of tool administration and identification of anxiety and referrals to mental health care for treatment. Employing a pretest-posttest design, the effect of universal anxiety screening for adolescents was measured at well-child visits. RESULTS Anxiety screening and anxiety diagnosis rates were significantly increased post-implementation. DISCUSSION Universal screening for anxiety was efficacious in the project setting for identifying cases of anxiety.
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Cowley LE, Hodgson K, Song J, Whiffen T, Tan J, John A, Bandyopadhyay A, Davies AR. Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study. BMJ Open 2023; 13:e067882. [PMID: 37328187 PMCID: PMC10276955 DOI: 10.1136/bmjopen-2022-067882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020-31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019-31 January 2020, referred to as 2019/2020), between CEV children and the general population. DESIGN Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list. SETTING Primary and secondary healthcare settings covering 80% of the population of Wales. PARTICIPANTS Children aged 2-17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009). PRIMARY OUTCOME MEASURE First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes. RESULTS A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p<0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population. CONCLUSIONS Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic.
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Affiliation(s)
| | - Karen Hodgson
- Research and Evaluation Division, Public Health Wales, Cardiff, UK
| | - Jiao Song
- Health Protection Division, Public Health Wales, Cardiff, UK
| | - Tony Whiffen
- Administrative Data Research Unit, Welsh Government, Cardiff, UK
| | - Jacinta Tan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Alisha R Davies
- Research and Evaluation Division, Public Health Wales, Cardiff, UK
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John A, McGregor J, Marchant A, DelPozo-Baños M, Farr I, Nurmatov U, Kemp A, Naughton A. An external validation of coding for childhood maltreatment in routinely collected primary and secondary care data. Sci Rep 2023; 13:8138. [PMID: 37208469 PMCID: PMC10199091 DOI: 10.1038/s41598-023-34011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023] Open
Abstract
Validated methods of identifying childhood maltreatment (CM) in primary and secondary care data are needed. We aimed to create the first externally validated algorithm for identifying maltreatment using routinely collected healthcare data. Comprehensive code lists were created for use within GP and hospital admissions datasets in the SAIL Databank at Swansea University working with safeguarding clinicians and academics. These code lists build on and refine those previously published to include an exhaustive set of codes. Sensitivity, specificity and positive predictive value of previously published lists and the new algorithm were estimated against a clinically assessed cohort of CM cases from a child protection service secondary care-based setting-'the gold standard'. We conducted sensitivity analyses to examine the utility of wider codes indicating Possible CM. Trends over time from 2004 to 2020 were calculated using Poisson regression modelling. Our algorithm outperformed previously published lists identifying 43-72% of cases in primary care with a specificity ≥ 85%. Sensitivity of algorithms for identifying maltreatment in hospital admissions data was lower identifying between 9 and 28% of cases with high specificity (> 96%). Manual searching of records for those cases identified by the external dataset but not recorded in primary care suggest that this code list is exhaustive. Exploration of missed cases shows that hospital admissions data is often focused on the injury being treated rather than recording the presence of maltreatment. The absence of child protection or social care codes in hospital admissions data poses a limitation for identifying maltreatment in admissions data. Linking across GP and hospital admissions maximises the number of cases of maltreatment that can be accurately identified. Incidence of maltreatment in primary care using these code lists has increased over time. The updated algorithm has improved our ability to detect CM in routinely collected healthcare data. It is important to recognize the limitations of identifying maltreatment in individual healthcare datasets. The inclusion of child protection codes in primary care data makes this an important setting for identifying CM, whereas hospital admissions data is often focused on injuries with CM codes often absent. Implications and utility of algorithms for future research are discussed.
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Affiliation(s)
- Ann John
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Joanna McGregor
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Amanda Marchant
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Marcos DelPozo-Baños
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ian Farr
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ulugbek Nurmatov
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Alison Kemp
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
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Kiviruusu O, Haravuori H, Lindgren M, Therman S, Marttunen M, Suvisaari J, Aalto-Setälä T. Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19. J Affect Disord 2023; 330:267-274. [PMID: 36914117 PMCID: PMC10008046 DOI: 10.1016/j.jad.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend. METHODS Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression. RESULTS Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support. LIMITATIONS The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes. CONCLUSIONS Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.
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Affiliation(s)
- Olli Kiviruusu
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Henna Haravuori
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Lindgren
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sebastian Therman
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terhi Aalto-Setälä
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Rees S, Fry R, Davies J, John A, Condon L. Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study. PLoS One 2023; 18:e0281504. [PMID: 36800353 PMCID: PMC9937479 DOI: 10.1371/journal.pone.0281504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites. METHODS Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University's SAIL Databank, we created a cohort of Traveller site residents aged 11-25 years old, 2010-2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm. RESULTS Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population. CONCLUSIONS Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.
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Affiliation(s)
- Sarah Rees
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Jason Davies
- School of Psychology, Swansea University, Swansea, United Kingdom
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Louise Condon
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
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Abstract
Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person's development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English.
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Affiliation(s)
- Angela Preston
- School of Nursing, 16168University of Texas, Austin, USA
| | - Lynn Rew
- School of Nursing, 16168University of Texas, Austin, USA
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Barker MM, Beresford B, Fraser LK. Incidence of anxiety and depression in children and young people with life-limiting conditions. Pediatr Res 2022:10.1038/s41390-022-02370-8. [PMID: 36369475 DOI: 10.1038/s41390-022-02370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the incidence of anxiety and depression in children and young people with life-limiting conditions. METHODS A comparative cohort study was conducted, using primary and secondary care data from the Clinical Practice Research Datalink (CPRD) in England. Anxiety and depression codes were identified using diagnostic, symptom and prescription codes. Incidence rates of anxiety and depression were compared across condition groups using Poisson regression, adjusting for sex, age, ethnicity, and deprivation status. RESULTS A total of 25,313 children and young people were included in the study: 5527 with life-limiting conditions, 6729 with chronic conditions, and 13,057 with no long-term conditions. The incidence of anxiety (IRRadj: 1.39, 95% CI: 1.09-1.77) and depression (IRRadj: 1.41, 95% CI: 1.08-1.83) was significantly higher in children and young people with life-limiting conditions, compared to children and young people with no long-term conditions. CONCLUSIONS The higher incidence of anxiety and depression observed among children and young people with life-limiting conditions highlights the need for psychological support in this population, including further efforts to prevent, identify, and treat anxiety and depression. IMPACT The analysis of primary and secondary healthcare data from England revealed that the incidence of anxiety and depression was higher among children and young people with life-limiting conditions, compared to those with no long-term conditions. This is the first study to investigate the incidence of anxiety and depression in children and young people with a wide range of life-limiting conditions. The higher incidence of anxiety and depression observed in children and young people with life-limiting conditions highlights the need for psychological support aiming to prevent, identify, and treat anxiety and depression in this population group.
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Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK. .,Martin House Research Centre, Department of Health Sciences, University of York, York, UK.
| | - Bryony Beresford
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK.,Social Policy Research Unit, University of York, York, UK
| | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Klau J, Bernardo CDO, Gonzalez-Chica DA, Raven M, Jureidini J. Trends in prescription of psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. Aust N Z J Psychiatry 2022; 56:1477-1490. [PMID: 34963342 DOI: 10.1177/00048674211067720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. METHOD A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0-4, 5-9, 10-14, 15-18 years). Melatonin was analysed separately. RESULTS The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [-8.0%, -5.0%]; overall -40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. CONCLUSION General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.
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Affiliation(s)
- Julie Klau
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - David Alejandro Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Management of anxiety disorders among children and adolescents in UK primary care: A cohort study. J Affect Disord 2022; 313:270-277. [PMID: 35803390 DOI: 10.1016/j.jad.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety disorders are common in childhood and adolescence but evidence-based guidance on their management is limited in the UK. In the absence of guidelines, we examined what treatment young people with anxiety disorders receive in primary care in the year following diagnosis. METHOD We delineated a cohort of individuals diagnosed with anxiety disorders aged 10-18 using the Clinical Practice Research Datalink (CPRD). We estimated the annual prevalence of antidepressant and anxiolytic prescribing and referrals to mental health services in the year following diagnosis between 2003 and 2019 via Poisson models, adjusted for age, gender, and practice-level deprivation. RESULTS 34,490 out of 52,358 (66 %) individuals were not prescribed or referred in the year following diagnosis. Those registered to practices in the most deprived compared to the least deprived areas were less likely to be referred (PR 0.80, 95%CI 0.76-0.84) and prescribed antidepressants (PR 0.77, 95%CI 0.72-0.82). Referrals increased 2003-2008 (22-28 %) and then declined until 2019 (28-21 %). Antidepressant prescribing decreased substantially between 2003 and 2005 (18-11 %) and then increased slightly between 2006 and 2019 (11-13 %). Anxiolytic prescribing declined between 2003 and 2019 (10-2 %). LIMITATIONS Prescriptions in the CPRD are not coupled with information about indication. Some prescriptions may therefore have been incorrectly attributed to the treatment of anxiety disorders. CONCLUSION The continued use of antidepressants necessitates the development of evidence-based guidance. The lower likelihood of being prescribed medication and/or referred among young people in more deprived practice populations, where incidence of anxiety disorder and other mental illnesses is higher, must also be investigated and rectified.
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Affiliation(s)
- Lukasz Cybulski
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK.
| | - Darren M Ashcroft
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester and Manchester Academic Health Sciences Centre, UK
| | - Matthew J Carr
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester and Manchester Academic Health Sciences Centre, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester & and Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffs, UK
| | - Nav Kapur
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink. J Child Psychol Psychiatry 2022; 63:1078-1088. [PMID: 34862981 DOI: 10.1111/jcpp.13552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD We delineated two nested case-control studies of patients aged 10-19 years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N = 324) - study 1; experienced their first self-harm episode (N = 56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention.
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Affiliation(s)
- Lukasz Cybulski
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Primary, Community and Social Care, Keele University, Staffs, UK
| | - Nav Kapur
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Koet LB, de Schepper EI, Bohnen AM, Bindels PJ, Gerger H. Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care. Br J Gen Pract 2022; 72:e405-e412. [PMID: 35440466 PMCID: PMC9037188 DOI: 10.3399/bjgp.2021.0557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Due to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce. AIM To investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs' management of children and adolescents presenting with anxiety problems. DESIGN AND SETTING Population-based cohort study using electronic medical records of 51 212 children (aged 0-17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018. METHOD Incidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs' management were assessed qualitatively using quantitative content analysis. RESULTS Incidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person-years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person-years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence. CONCLUSION In general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice.
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Affiliation(s)
- Lukas Bm Koet
- Department of General Practice, Erasmus Medical Centre, the Netherlands
| | | | - Arthur M Bohnen
- Department of General Practice, Erasmus Medical Centre, the Netherlands
| | | | - Heike Gerger
- Department of General Practice, Erasmus Medical Centre, the Netherlands; Department of General Practice and Family Medicine, University of Bielefeld, Bielefeld, Germany
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12
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Khanal P, Ståhlberg T, Luntamo T, Gyllenberg D, Kronström K, Suominen A, Sourander A. Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders. BMC Psychiatry 2022; 22:144. [PMID: 35193518 PMCID: PMC8864838 DOI: 10.1186/s12888-022-03743-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings. METHODS This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born). RESULTS Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%). CONCLUSION Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.
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Affiliation(s)
- Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland. .,INVEST Research Flagship Center, University of Turku, Turku, Finland.
| | - Tiia Ståhlberg
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship Center, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Terhi Luntamo
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship Center, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - David Gyllenberg
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship Center, University of Turku, Turku, Finland ,grid.14758.3f0000 0001 1013 0499National Institute of Health and Welfare, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Adolescent Psychiatry, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Kim Kronström
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Auli Suominen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Andre Sourander
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship Center, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
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Gagné T, Schoon I, McMunn A, Sacker A. Mental distress among young adults in Great Britain: long-term trends and early changes during the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1261-1272. [PMID: 34766187 PMCID: PMC8583581 DOI: 10.1007/s00127-021-02194-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/31/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE In Great Britain, few studies documented mental health trends in young adults in the years preceding 2020, the mental health dimensions affected, and how these compare with changes observed during the COVID-19 pandemic. METHODS Long-term trends in mental health among 16-34 year old men and women between 1991 and 2018, and changes between 2018-19 and July-September 2020 were examined using all waves from the British Household Panel Study (1991-2008), the UK Household Longitudinal Study (2009-20), and the first five UKHLS COVID-19 waves administered in April, May, June, July, and September 2020. Findings are based on the GHQ-12 continuous score (0-36), clinically significant cases (4 + /12) and severe cases (7 + /12) for mental distress, and item endorsements. RESULTS Between 1991 and 2018, the prevalence of cases (4 + /12) increased from 14-22% to 19-32% across groups. Increases were largest in women aged 16-24. In April 2020, the risk of caseness (4 + /12) increased across groups by 55% to 80% compared to the 2018-19 baseline. This increase, however, rapidly diminished over time: in July-September 2020, there was only a higher risk of caseness (4 + /12) in men aged 25-34 (prevalence ratio = 1.29, 95% CI 1.01-1.65) compared to the 2018-19 baseline. CONCLUSION Whereas distress surged in April 2020, its return to pre-pandemic levels by September 2020 highlights the nuanced impact that the pandemic may have over time. Given the magnitude of the decline in mental health over the past decade, attention must be given to young adults once the pandemic ends.
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Affiliation(s)
- T. Gagné
- International Centre for Lifecourse Studies in Society and Health, London, UK ,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, office 536, London, WC1E 6BT UK
| | - I. Schoon
- Social Research Institute, UCL, London, UK
| | - A. McMunn
- International Centre for Lifecourse Studies in Society and Health, London, UK ,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, office 536, London, WC1E 6BT UK
| | - A. Sacker
- International Centre for Lifecourse Studies in Society and Health, London, UK ,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, office 536, London, WC1E 6BT UK
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14
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Archer C, Turner K, Kessler D, Mars B, Wiles N. Trends in the recording of anxiety in UK primary care: a multi-method approach. Soc Psychiatry Psychiatr Epidemiol 2022; 57:375-386. [PMID: 34196743 PMCID: PMC8246441 DOI: 10.1007/s00127-021-02131-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/22/2021] [Indexed: 12/05/2022]
Abstract
PURPOSE Anxiety disorders are common. Between 1998 and 2008, in the UK, GP recording of anxiety symptoms increased, but the recording of anxiety disorders decreased. We do not know whether such trends have continued. This study examined recent trends in the recording of anxiety and explored factors that may influence GPs' coding of anxiety. METHODS We used data from adults (n = 2,569,153) registered with UK general practices (n = 176) that contributed to the Clinical Practice Research Datalink between 2003 and 2018. Incidence rates and 95% confidence intervals were calculated for recorded anxiety symptoms and diagnoses and were stratified by age and gender. Joinpoint regression was used to estimate the years trends changed. In addition, in-depth interviews were conducted with 15 GPs to explore their views and management of anxiety. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The incidence of anxiety symptoms rose from 6.2/1000 person-years at risk (PYAR) in 2003 to 14.7/1000 PYAR in 2018. Between 2003 and 2008, the incidence of anxiety diagnoses fell from 13.2 to 10.1/1000 PYAR; markedly increasing between 2013 and 2018 to 15.3/1000 PYAR. GPs mentioned that they preferred using symptom codes to diagnostic codes to avoid assigning potentially stigmatising or unhelpful labels, and commented on a rise in anxiety in recent years, especially in young adults. CONCLUSION Recent increases in the recording of both anxiety diagnoses and symptoms may reflect increased presentation to primary care, especially in young adults. There is a clear need to understand the reasons for this, and this knowledge may be critical in the prevention and treatment of anxiety.
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Affiliation(s)
- Charlotte Archer
- Bristol Medical School, Centre for Academic Mental Health, University of Bristol, Population Health Sciences, Bristol, BS8 2BN, UK.
| | - Katrina Turner
- grid.5337.20000 0004 1936 7603Bristol Medical School, Centre for Academic Mental Health, University of Bristol, Population Health Sciences, Bristol, BS8 2BN UK ,grid.410421.20000 0004 0380 7336The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Kessler
- grid.5337.20000 0004 1936 7603Bristol Medical School, Centre for Academic Mental Health, University of Bristol, Population Health Sciences, Bristol, BS8 2BN UK ,grid.511076.4NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Becky Mars
- grid.5337.20000 0004 1936 7603Bristol Medical School, Centre for Academic Mental Health, University of Bristol, Population Health Sciences, Bristol, BS8 2BN UK ,grid.511076.4NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Nicola Wiles
- grid.5337.20000 0004 1936 7603Bristol Medical School, Centre for Academic Mental Health, University of Bristol, Population Health Sciences, Bristol, BS8 2BN UK ,grid.511076.4NIHR Bristol Biomedical Research Centre, Bristol, UK
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15
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Rees S, Watkins A, Keauffling J, John A. Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales. Clin Epidemiol 2022; 14:21-38. [PMID: 35058718 PMCID: PMC8764170 DOI: 10.2147/clep.s325235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK. METHODS A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11-25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan-Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC). RESULTS Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12-1.24) in WLGP and 1.17 (1.10-1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20-29.40) in WLGP and 4.50 (4.08-4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00-3.58) in WLGP and 2.59 (2.36-2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78-0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54-0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84-1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5-10.0). CONCLUSION Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.
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Affiliation(s)
- Sarah Rees
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
- Correspondence: Sarah Rees Email
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | | | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
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16
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OJEWALE LUCIAYETUNDE. Psychological state, family functioning and coping strategies among undergraduate students in a Nigerian University during the COVID-19 lockdown. J Prev Med Hyg 2021; 62:E285-E295. [PMID: 34604567 PMCID: PMC8451335 DOI: 10.15167/2421-4248/jpmh2021.62.2.1798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The curtailment of social gatherings and the lack of online academic engagement during the COVID-19 lockdown could have potentially damaging effects on the psychological state of university students in Nigerian public universities. This study examined the prevalence of anxiety and depression, including associated factors and coping methods, among undergraduate students. METHODS This cross-sectional study, which involved 386 undergraduate students, was assigned approval number UI/EC/20/0242. An online questionnaire consisting mainly of the Hospital Anxiety and Depression Scale and the McMaster Family Assessment Device was circulated among the students. The results were analysed by means of descriptive statistics, chi-square, Analysis of Variance (ANOVA) and linear logistical regression, at α 0.05. RESULTS Mean age was 21 ± 2.9 years, with females constituting 60.1% of the sample. The prevalence rates of anxiety and depression were 41.5 and 31.9%, respectively. Students in health-related faculties were significantly less anxious than others. Inability to afford three square meals, negative family functioning, chronic illness and living in a State/Region with a high incidence of COVID-19 were significantly associated with depression. These factors jointly accounted for 14% of depression. Coping methods included the use of social media, watching movies and participating in online skills-development programs. CONCLUSION The overall level of anxiety and depression among undergraduate students during the COVID-19 lockdown was higher than the levels previously reported. Inadequate nutrition and poor family functioning contributed significantly to this. Proactive measures ought to be taken to support undergraduate students in order to prevent the negative consequences of poor mental health.
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Affiliation(s)
- LUCIA YETUNDE OJEWALE
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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17
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003-2018. BMC Psychiatry 2021; 21:229. [PMID: 33941129 PMCID: PMC8092997 DOI: 10.1186/s12888-021-03235-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/08/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. METHODS Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1-20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1-5, 6-9, 10-12, 13-16, 17-19), depression, anxiety disorders (6-9, 10-12, 13-16, 17-19), eating disorders and self-harm (10-12, 13-16, 17-19) during 2003-2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. RESULTS The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18-3.89), depression (2.37; 2.03-2.77), ASD (2.36; 1.72-3.26), ADHD (2.3; 1.73-3.25), and self-harm (2.25; 1.82-2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06-1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. CONCLUSION The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.
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Affiliation(s)
- Lukasz Cybulski
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK. .,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK.
| | - Darren M. Ashcroft
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL UK ,grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matthew J. Carr
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL UK ,grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shruti Garg
- grid.5379.80000000121662407Neuroscience & Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester and Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A. Chew-Graham
- grid.9757.c0000 0004 0415 6205School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffs, ST5 5BG UK
| | - Nav Kapur
- grid.5379.80000000121662407Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, M13 9PL UK ,grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL UK ,grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T. Webb
- grid.5379.80000000121662407Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, M13 9PL UK ,grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL UK
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de Sousa Lima JL, de Oliveira Cavalcante AM, Chagas AKO, Leite GDO, Campos AR. Audiovisual overstimulation in childhood and adolescence promotes hyperactive behaviour in adult mice. Physiol Behav 2021; 233:113348. [PMID: 33545208 DOI: 10.1016/j.physbeh.2021.113348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
There is a discussion about the impact of technological development on behavioural aspects, a nuance that the present study aimed to assess. p21, p26 and p36 mice were subjected to audio (70 db) and visual stimulation (flashing lights) for 2 or 6 h per day until p64. Naive animals were included. From p74 onwards, the animals were subjected to tests to assess their locomotion, depression, anxiety, aggressiveness, and nociception behaviours. Weight assessment was also performed. The animals that received stimulation for 2 h a day since p21 showed a decrease in rearing and grooming behaviour in the open field test, as well as in the mechanical orofacial sensitivity. Animals that received stimulation for 6 h daily since p21 showed increased locomotor activity in the open field test. Animals that received stimulation for 2 h a day since p26 showed an increase in locomotor activity and a decrease in grooming behaviour in the open field test, in addition to a reduction in the number of entries in the closed arm of the elevated plus maze. Animals stimulated from p26 for 6 h daily increased the reaction time to the thermal stimulus. Animals that received stimulation for 2 h daily since p36 showed an increase in locomotor activity and a decrease in grooming behaviour in the open field test. Taken together, these findings suggest that audiovisual overstimulation during critical periods of brain development may have adverse effects compatible with hyperactivity in adulthood.
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Noon SL, D'Annibale DA, Schwimmer MH, Shiels J, Arin J, Durelle J, Newton KP, Goyal NP, Schwimmer JB. Incidence of Depression and Anxiety in a Cohort of Adolescents With Nonalcoholic Fatty Liver Disease. J Pediatr Gastroenterol Nutr 2021; 72:579-583. [PMID: 33346572 PMCID: PMC8815421 DOI: 10.1097/mpg.0000000000003024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the incidence of clinically diagnosed depression and anxiety in adolescents with nonalcoholic fatty liver disease (NAFLD). METHODS This was a prospective, longitudinal cohort study between January 1, 2012 and July 1, 2018 conducted in a Children's Hospital Pediatric Gastroenterology Clinic. Participants included adolescents 12 to 17 years old at baseline with biopsy-confirmed NAFLD. The primary outcomes were having depression and/or anxiety based upon a clinical diagnosis established by a physician or psychologist. The rates of depression and anxiety were measured at baseline and longitudinally throughout follow-up. RESULTS A total of 160 adolescents with NAFLD were followed for a mean of 3.8 years. At baseline, 8.1% had a diagnosis of depression. During follow-up, an additional 9.5% (95% confidence interval, 4.7-14.3) developed depression. The incidence density of depression was 27 new cases per 1000 person-years at risk. In adolescents with NAFLD, 6.3% had anxiety at baseline and 6.7% (95% confidence interval, 2.6-10.7) developed anxiety during follow-up. The incidence density of anxiety was 18 new cases per 1000 person-years at risk. The change in alanine aminotransferase was significantly worse for adolescents with NAFLD who developed depression compared to those who did not develop depression (P < 0.01). CONCLUSIONS Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.
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Affiliation(s)
- Sheila L Noon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- University of California Berkeley, Berkeley, CA
| | - Danielle A D'Annibale
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Georgetown University School of Medicine, Washington, DC
| | - Melanie H Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Amherst College, Amherst, MA
| | - Jacqueline Shiels
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Psychiatry, Kaiser Permanente, Antioch
| | - Jennifer Arin
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
| | - Janis Durelle
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
| | - Kimberly P Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| | - Nidhi P Goyal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
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John A, Marchant A, Demmler J, Tan J, DelPozo-Banos M. Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank. BJPsych Open 2021; 7:e67. [PMID: 33736714 PMCID: PMC8058850 DOI: 10.1192/bjo.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes. AIMS To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring. METHOD We conducted a retrospective whole population e-cohort study of individuals aged 10-64 years from 2003 to 2016. Individuals were divided into: record of self-harm only; eating disorders only; both self-harm and eating disorders; and no record of self-harm or eating disorders. We used linked routinely collected healthcare data across primary care, emergency departments, hospital admissions and out-patient appointments to examine healthcare contacts and mortality. RESULTS We identified 82 627 individuals: n = 75 165 with self-harm only; n = 5786 with eating disorders only; n = 1676 with both combined. Across all groups and settings significantly more individuals attended with significantly more contacts than the rest of the population. The combined group had the highest number of contacts per person (general practitioner, incident rate ratio IRR = 3.3, 95% CI 3.1-3.5; emergency department, IRR = 5.2, 95% CI 4.7-5.8; hospital admission, IRR = 5.2, 95% CI 4.5-6.0; out-patients, IRR = 3.9, 95% CI 3.5-4.4). Standardised mortality ratios showed the highest excess mortality overall in the self-harm only group (SMR = 3.2, 95% CI 3.1-3.3), particularly for unnatural causes of death (SMR = 17.1, 95% CI 16.3-17.9). SMRs and years of life lost showed an increased risk of mortality in younger age groups in the combined group. Adjusted hazard ratios showed increased mortality across all groups (self-harm only, HR = 5.3, 95% CI 5.2-5.5; eating disorders only, HR = 4.1, 95% CI 3.4-4.9; combined group, HR = 6.8, 95% CI 5.4-8.6). CONCLUSIONS Individuals in all groups had higher healthcare service utilisation than the general population. The increased mortality risk in young people with a record of both eating disorders and self-harm highlights the need for early specialist intervention and enhanced support.
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Affiliation(s)
- Ann John
- FFPH, Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Amanda Marchant
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Joanne Demmler
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Jacinta Tan
- FRCPsych, Swansea University Medical School, Data Science Building, Swansea University, UK; and Specialist Eating Disorder Team, Abertawe Bro Morgannwg University Health Board, UK
| | - Marcos DelPozo-Banos
- Swansea University Medical School, Data Science Building, Swansea University, UK
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Barclay RP, Dillon-Naftolin E, Russell D, Hilt RJ. A Second-Opinion Program for the Care of Youths Prescribed Five or More Psychotropics in Washington State. Psychiatr Serv 2021; 72:362-365. [PMID: 32878541 DOI: 10.1176/appi.ps.202000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This retrospective study describes a second-opinion review program for the care of children in Washington State who received Medicaid coverage and who were prescribed five or more psychotropic medications, primarily by mental health specialists. In total, 136 second-opinion reviews from 2013 and 169 from 2018 were included in this study. Attention-deficit hyperactivity disorder (ADHD), behavioral difficulties, anxiety, and trauma were prevalent among these children, and participants were commonly prescribed ADHD medications, selective serotonin reuptake inhibitors, and second-generation antipsychotics. The incidence of reviews remained stable over the two periods, but psychosocial treatment increased significantly over this time. This study sheds light on the initiation, maintenance, and identification of polypharmacy psychotropic regimens and highlights psychosocial treatment as an intervention that increases best practice care for at-risk patients.
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Affiliation(s)
- Rebecca P Barclay
- Partnership Access Line, Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle (Barclay); Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dillon-Naftolin, Russell, Hilt). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Erin Dillon-Naftolin
- Partnership Access Line, Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle (Barclay); Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dillon-Naftolin, Russell, Hilt). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Douglas Russell
- Partnership Access Line, Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle (Barclay); Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dillon-Naftolin, Russell, Hilt). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Robert J Hilt
- Partnership Access Line, Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle (Barclay); Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dillon-Naftolin, Russell, Hilt). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
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Lounsbury O, Roberts L, Goodman JR, Batey P, Naar L, Flott KM, Lawrence-Jones A, Ghafur S, Darzi A, Neves AL. Opening a "Can of Worms" to Explore the Public's Hopes and Fears About Health Care Data Sharing: Qualitative Study. J Med Internet Res 2021; 23:e22744. [PMID: 33616532 PMCID: PMC7939935 DOI: 10.2196/22744] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/27/2020] [Accepted: 01/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence suggests that health care data sharing may strengthen care coordination, improve quality and safety, and reduce costs. However, to achieve efficient and meaningful adoption of health care data-sharing initiatives, it is necessary to engage all stakeholders, from health care professionals to patients. Although previous work has assessed health care professionals' perceptions of data sharing, perspectives of the general public and particularly of seldom heard groups have yet to be fully assessed. OBJECTIVE This study aims to explore the views of the public, particularly their hopes and concerns, around health care data sharing. METHODS An original, immersive public engagement interactive experience was developed-The Can of Worms installation-in which participants were prompted to reflect about data sharing through listening to individual stories around health care data sharing. A multidisciplinary team with expertise in research, public involvement, and human-centered design developed this concept. The installation took place in three separate events between November 2018 and November 2019. A combination of convenience and snowball sampling was used in this study. Participants were asked to fill self-administered feedback cards and to describe their hopes and fears about the meaningful use of data in health care. The transcripts were compiled verbatim and systematically reviewed by four independent reviewers using the thematic analysis method to identify emerging themes. RESULTS Our approach exemplifies the potential of using interdisciplinary expertise in research, public involvement, and human-centered design to tell stories, collect perspectives, and spark conversations around complex topics in participatory digital medicine. A total of 352 qualitative feedback cards were collected, each reflecting participants' hopes and fears for health care data sharing. Thematic analyses identified six themes under hopes: enablement of personal access and ownership, increased interoperability and collaboration, generation of evidence for better and safer care, improved timeliness and efficiency, delivery of more personalized care, and equality. The five main fears identified included inadequate security and exploitation, data inaccuracy, distrust, discrimination and inequality, and less patient-centered care. CONCLUSIONS This study sheds new light on the main hopes and fears of the public regarding health care data sharing. Importantly, our results highlight novel concerns from the public, particularly in terms of the impact on health disparities, both at international and local levels, and on delivering patient-centered care. Incorporating the knowledge generated and focusing on co-designing solutions to tackle these concerns is critical to engage the public as active contributors and to fully leverage the potential of health care data use.
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Affiliation(s)
- Olivia Lounsbury
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
- Patient Safety Movement Foundation, Irvine, CA, United States
| | - Lily Roberts
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Jonathan R Goodman
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Philippa Batey
- The Helix Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Lenny Naar
- The Helix Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Kelsey M Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Anna Lawrence-Jones
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Saira Ghafur
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom
- Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
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Chan HY, Cheng SW, Sun HJ. Prescription patterns and trends of anxiolytics and hypnotics/sedatives among child and adolescent patients with psychiatric illnesses in a psychiatric center of northern Taiwan. Taiwan J Psychiatry 2021. [DOI: 10.4103/tpsy.tpsy_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ask H, Handal M, Hauge LJ, Reichborn-Kjennerud T, Skurtveit S. Incidence of diagnosed pediatric anxiety disorders and use of prescription drugs: a nation-wide registry study. Eur Child Adolesc Psychiatry 2020; 29:1063-73. [PMID: 31641902 DOI: 10.1007/s00787-019-01419-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/03/2019] [Indexed: 01/04/2023]
Abstract
The aim of this study was to calculate time trends in incidence of diagnosed anxiety disorders, including obsessive-compulsive disorder, and post-traumatic stress disorder, and to examine changes in use of prescribed drugs in the Norwegian pediatric population. Furthermore, we aimed to investigate whether comorbid mental disorders are associated with the use of prescribed drugs. Nation-wide registries with data from 2008 to 2015 were used, covering diagnostic data from primary health care [the Norwegian database for the control and reimbursement of health expenses (KUHR)] and secondary health care [the Norwegian Patient registry (NPR)], and data on prescribed drugs [the Norwegian prescription database, (NorPD)]. Data from the two latter were linked. During the period 2010-2015, 19,154 children and adolescents (61% girls) received a first diagnosis of anxiety disorders in primary care. The corresponding number from secondary care was 17,115 (61% girls). The incidence of diagnosed anxiety disorders increased over time, especially in girls, with an overall raise of ~ 2 per 1000 children across 2010-2015. Anti-anxiety drugs were used by < 12% of diagnosed children and < 25% of diagnosed adolescents, mainly by those with several contacts with the specialist health care system. There was no strong indications of an increase over time. Of other drugs, the most frequently prescribed were hypnotics and psychostimulants. Psychiatric comorbidity (33-55%) contributed to the use of drugs, including anti-anxiety drugs. The incidence of diagnosed anxiety disorders increased from 2010 to 2015, but the percentage using anti-anxiety drugs was stable. Drug use appears to be in line with the Norwegian guidelines.
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Marchant A, Turner S, Balbuena L, Peters E, Williams D, Lloyd K, Lyons R, John A. Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK. Arch Dis Child 2020; 105:347-354. [PMID: 31611193 PMCID: PMC7146921 DOI: 10.1136/archdischild-2019-317248] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10-24 years old in Wales, UK. METHODS A whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented. RESULTS A total of 937 697 individuals aged 10-24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15-19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10-15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty. CONCLUSIONS This is the first study to compare self-harm in people aged 10-24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.
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Affiliation(s)
- Amanda Marchant
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Samantha Turner
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Evyn Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Dave Williams
- Child and Adolescent Psychiatry, Aneurin Bevan Health Board, Newport, UK
| | - Keith Lloyd
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Barczyk ZA, Rucklidge JJ, Eggleston M, Mulder RT. Psychotropic Medication Prescription Rates and Trends for New Zealand Children and Adolescents 2008-2016. J Child Adolesc Psychopharmacol 2020; 30:87-96. [PMID: 31633377 DOI: 10.1089/cap.2019.0032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: The prescription of psychotropic medication used to treat psychiatric disorders has increased worldwide over the past two decades and has been discussed widely in the literature; however, limited data have been available for New Zealand. The current article aimed to address this knowledge gap. Methods: Prescription data obtained from The Pharmaceutical Management Agency of New Zealand (PHARMAC) were analyzed to obtain prescription dispensing rates and trends for antidepressants, antipsychotics, anxiolytics, sedatives and hypnotics, and stimulants/attention-deficit/hyperactivity disorder medications for youth aged 0-17 years in New Zealand during 2008-2016, including a gender and ethnicity breakdown for 2016 to provide a "snapshot" of prescription demographics. These data sets contained all individual prescriptions dispensed in New Zealand during this time period, alongside a unique encrypted National Health Index number to distinguish individuals and demographic data. Results: In 2016, 2.36% of New Zealand youth, totaling 26,175 individuals, were prescribed at least one psychotropic medication, an increase of 65.03% from 2008. Rate of prescription for youth in 2016 and percentage increase since 2008 for each medication class were as follows: antidepressants: 1.07%, 78.33% increase; antipsychotics: 0.37%, 105.60% increase; anxiolytics: 0.15%, 50% increase; and sedatives and hypnotics: 0.22%, 37.50% increase. Stimulants were prescribed to 1.06% of the population, a 41.33% increase since 2011. In 2016 the number of prescriptions was split roughly equally between males and females, with more males receiving stimulant prescriptions and more females receiving antidepressant prescriptions. Stimulants were the medication most likely to be prescribed to Māori, Pacific, and Middle Eastern/Latin American/African groups, with antidepressants most likely for European and Asian groups. Māori tended to be prescribed medications at rates lower than the general population. Conclusions: Overall, prescription rates and the increase in prescription of psychotropic medication to children and adolescents in New Zealand fall within the mid range compared to other Western countries worldwide.
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Affiliation(s)
- Zoe A Barczyk
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Matthew Eggleston
- Child, Adolescent & Family Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Cordovilla-Guardia S, Molina TB, Franco-Antonio C, Santano-Mogena E, Vilar-López R. Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age. PLoS One 2020; 15:e0227696. [PMID: 31940406 PMCID: PMC6961940 DOI: 10.1371/journal.pone.0227696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/26/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship. Method From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied. Results A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40–2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age. Conclusions The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.
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Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
- * E-mail:
| | | | - Cristina Franco-Antonio
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
| | - Esperanza Santano-Mogena
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Andalusian Observatory on Drugs and Addictions, Granada, Spain
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Neves AL, Poovendran D, Freise L, Ghafur S, Flott K, Darzi A, Mayer EK. Health Care Professionals' Perspectives on the Secondary Use of Health Records to Improve Quality and Safety of Care in England: Qualitative Study. J Med Internet Res 2019; 21:e14135. [PMID: 31573898 PMCID: PMC6787532 DOI: 10.2196/14135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/08/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Health care professionals (HCPs) are often patients' first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHRs) for nondirect care purposes. Their engagement is fundamental to ensure patients' buy-in and a successful implementation of health care data sharing schemes. However, their views on this subject are seldom evaluated. OBJECTIVE This study aimed to explore HCPs' perspectives on the secondary uses of health care data in England. Specifically, we aimed to assess their knowledge on its purposes and the main concerns about data sharing processes. METHODS A total of 30 interviews were conducted between March 27, 2017, and April 7, 2017, using a Web-based interview platform and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East England, and Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using the framework analysis method to identify emerging themes. RESULTS HCPs were knowledgeable about the possible secondary uses of data and highlighted its importance for patient profiling and tailored care, research, quality assurance, public health, and service delivery planning purposes. Main concerns toward data sharing included data accuracy, patients' willingness to share their records, challenges on obtaining free and informed consent, data security, lack of adequacy or understanding of current policies, and potential patient exposure and exploitation. CONCLUSIONS These results suggest a high level of HCPs' understanding about the purposes of data sharing for secondary purposes; however, some concerns still remain. A better understanding of HCPs' knowledge and concerns could inform national communication policies and improve tailoring to maximize efficiency and improve patients' buy-in.
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Affiliation(s)
- Ana Luísa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dilkushi Poovendran
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Lisa Freise
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Saira Ghafur
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Erik K Mayer
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Wood S, Marchant A, Allsopp M, Wilkinson K, Bethel J, Jones H, John A. Epidemiology of eating disorders in primary care in children and young people: a Clinical Practice Research Datalink study in England. BMJ Open 2019; 9:e026691. [PMID: 31378721 PMCID: PMC6688704 DOI: 10.1136/bmjopen-2018-026691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Examination of current temporal trends and clinical management patterns of eating disorders (ED) in primary care is lacking. We aimed to calculate annual incidence rates of EDs in primary care by age, sex and deprivation. We also explored the care received through referrals, psychotropic prescriptions and associated secondary care service use. PARTICIPANTS AND SETTINGS A retrospective electronic cohort study was conducted using the Clinical Practice Research Datalink in those aged 11-24 years between 2004 and 2014 in England (n=1 135 038). RESULTS A total of 4775 individuals with a first ever recorded ED diagnosis were identified. The crude incidence rate was 100.1 per 100 000 person years at risk (95% CI 97.2 to 102.9). Incidence rates were highest in females (189.3 per 100 000 person years, 95% CI 183.7 to 195.0, n=4336), 16-20 years of age (141.0 per 100 000 person years, 95% CI 135.4 to 146.9, n=2348) and individuals from the least deprived areas (115.8 per 100 000 person years (95% CI 109.3 to 122.5, n=1203). Incidence rates decreased across the study period (incidence rate ratio (IRR) 0.6, 95% CI 0.5 to 0.8), particularly for individuals with bulimia nervosa (IRR 0.5, 95% CI 0.3 to 0.7) and from the most deprived areas (IRR 0.5, 95% CI 0.4 to 0.7). A total of 17.4% (95% CI 16.3 to 18.5, n=831) of first ever recorded ED cases were referred from primary to secondary care. 27.1% (95% CI 25.9 to 28.4, n=1294) of individuals had an inpatient admission 6 months before or 12 months after an incident ED diagnosis and 53.4% (95% CI 52.0 to 54.9, n=2550) had an outpatient attendance. Antidepressants were the most commonly prescribed psychotropic medication. CONCLUSIONS New ED presentations in primary care are reducing. Understanding the cause of this decrease (coding behaviours, changes in help-seeking or a genuine reduction in new cases) is important to plan services, allocate resources and deliver effective care.
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Affiliation(s)
- Sophie Wood
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Amanda Marchant
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
| | - Mark Allsopp
- Child and Adolescent Psychiatry, Berkshire Healthcare NHS Foundation Trust, England, UK
- NCEPOD, London, UK
| | | | - Jackie Bethel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Hywel Jones
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
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30
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Piovani D, Clavenna A, Bonati M. Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data. Eur J Clin Pharmacol 2019; 75:1333-1346. [DOI: 10.1007/s00228-019-02711-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
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Yap M, Tuson M, Whyatt D, Vickery A. Anxiety and alcohol in the working-age population are driving a rise in mental health-related emergency department presentations: 15 year trends in emergency department presentations in Western Australia. Emerg Med Australas 2019; 32:80-87. [PMID: 31264385 DOI: 10.1111/1742-6723.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate age, gender and disease-specific trends in ED for mental health presentations over 15 years. METHODS The study population consisted of residents of metropolitan Perth, Western Australia, presenting to Perth ED between 1 July 2002 and 30 June 2017. Population rates of mental health-related ED presentations per year were calculated. RESULTS Rates of mental health ED presentations are significantly increasing in the working-age population for those with stress and anxiety-related diagnoses, particularly in younger females, and also for alcohol-related presentations for those aged 10-49 years, particularly in males. CONCLUSION The present study demonstrates that increased rates of mental health-related ED presentations are driven by increased rates of presentation for stress and anxiety-related and alcohol-related presentations in both genders across the working-age population.
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Affiliation(s)
- Matthew Yap
- Division of General Practice, School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Tuson
- Division of General Practice, School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Whyatt
- Division of General Practice, School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Alistair Vickery
- Division of General Practice, School of Medicine, Faculty of Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Mathias TL, Guidoni CM, Girotto E. Trends of drug-related poisoning cases attended to at a poison control center. Rev Bras Epidemiol 2019; 22:e190018. [PMID: 30942327 DOI: 10.1590/1980-549720190018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Drug-related poisonings have a high impact on morbidity and mortality, representing the first cause of intoxication in Brazil. OBJECTIVE To describe the trends of cases of drug-related poisonings attended to by a poison control center. METHOD A quantitative approach (cross-sectional trend study) with data analysis of cases of drug-related poisonings attended to at the Poison Control Center of University Hospital of the State University of Londrina. Data were collected from service notification records for the period 1985 to 2014. For statistical analysis, a simple linear regression model was used. RESULTS Of the 36,707 cases attended to by the service, 22.5% (n = 8,608) were drug-related poisonings. There was an increase in the proportion of cases for both sexes (R2 = 0.195, p = 0.014) and males (R2 = 0.403, p < 0.001). There was a trend towards a higher proportion of cases involving the analgesic, anti-inflammatory and immunosuppressive drug classes (R2 = 0.521, p = 0.018), antidepressants (R2 = 0.923, p < 0.001) and antipsychotics (R2 = 0.869; p < 0.001). Antibiotics showed a trend toward a lower proportion of cases (R2 = 0.773, p = 0.001). CONCLUSIONS There was a trend for a higher proportion of cases of drug-related poisonings in males. Also, there was an increased trend towards cases involving analgesics/anti-inflammatories/immunosuppressants, antidepressants and antipsychotics.
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Affiliation(s)
- Thays Lopes Mathias
- Curso de Farmácia, Universidade Estadual de Londrina - Londrina (PR), Brasil
| | - Camilo Molino Guidoni
- Departamento de Ciências Farmacêuticas, Universidade Estadual de Londrina - Londrina (PR), Brasil
| | - Edmarlon Girotto
- Departamento de Ciências Farmacêuticas, Universidade Estadual de Londrina - Londrina (PR), Brasil
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Khouja JN, Munafò MR, Tilling K, Wiles NJ, Joinson C, Etchells PJ, John A, Hayes FM, Gage SH, Cornish RP. Is screen time associated with anxiety or depression in young people? Results from a UK birth cohort. BMC Public Health 2019; 19:82. [PMID: 30654771 PMCID: PMC6337855 DOI: 10.1186/s12889-018-6321-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/13/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is limited and conflicting evidence for associations between use of screen-based technology and anxiety and depression in young people. We examined associations between screen time measured at 16 years and anxiety and depression at 18. METHODS Participants (n = 14,665; complete cases n = 1869) were from the Avon Longitudinal Study of Parents and Children, a UK-based prospective cohort study. We assessed associations between various types of screen time (watching television, using a computer, and texting, all measured via questionnaire at 16y), both on weekdays and at weekends, and anxiety and depression (measured via the Revised Clinical Interview Schedule at 18y). Using ordinal logistic regression, we adjusted for multiple confounders, particularly focussing on activities that might have been replaced by screen time (for example exercising or playing outdoors). RESULTS More time spent using a computer on weekdays was associated with a small increased risk of anxiety (OR for 1-2 h = 1.17, 95% CI: 1.01 to 1.35; OR for 3+ hours = 1.30, 95% CI: 1.10 to 1.55, both compared to < 1 h, p for linear trend = 0.003). We found a similar association between computer use at weekends and anxiety (OR for 1-2 h = 1.17, 95% CI: 0.94 to 1.46; OR for 3+ hours = 1.28, 95% CI: 1.03 to 1.48, p for linear trend = 0.03). Greater time spent using a computer on weekend days only was associated with a small increased risk in depression (OR for 1-2 h = 1.12, 95% CI: 0.93 to 1.35; OR for 3+ hours = 1.35, 95% CI: 1.10 to 1.65, p for linear trend = 0.003). Adjusting for time spent alone attenuated effects for anxiety but not depression. There was little evidence for associations with texting or watching television. CONCLUSIONS We found associations between increased screen time, particularly computer use, and a small increased risk of anxiety and depression. Time spent alone was found to attenuate some associations, and further research should explore this.
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Affiliation(s)
- Jasmine N. Khouja
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Psychological Science, University of Bristol, Bristol, UK
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Psychological Science, University of Bristol, Bristol, UK
| | - Kate Tilling
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola J. Wiles
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Carol Joinson
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Ann John
- Swansea University Medical School, Swansea, UK
| | - Fiona M. Hayes
- University of Bristol Students’ Health Service, Bristol, UK
| | - Suzanne H. Gage
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Rosie P. Cornish
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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Tully MP, Bozentko K, Clement S, Hunn A, Hassan L, Norris R, Oswald M, Peek N. Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens' Juries. J Med Internet Res 2018; 20:e112. [PMID: 29592847 PMCID: PMC5895919 DOI: 10.2196/jmir.7763] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The secondary use of health data for research raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly between multiple-choice answers based on little information. OBJECTIVE The aim of this project was to extend knowledge about what control informed citizens would seek over the use of health records for research after participating in a deliberative process using citizens' juries. METHODS Two 3-day citizens' juries, of 17 citizens each, were convened to reflect UK national demographics from 355 eligible applicants. Each jury addressed the mission "To what extent should patients control access to patient records for secondary use?" Jurors heard from and questioned 5 expert witnesses (chosen either to inform the jury, or to argue for and against the secondary use of data), interspersed with structured opportunities to deliberate among themselves, including discussion and role-play. Jurors voted on a series of questions associated with the jury mission, giving their rationale. Individual views were polled using questionnaires at the beginning and at end of the process. RESULTS At the end of the process, 33 out of 34 jurors voted in support of the secondary use of data for research, with 24 wanting individuals to be able to opt out, 6 favoring opt in, and 3 voting that all records should be available without any consent process. When considering who should get access to data, both juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whereas jury 2 was more cautious and sought to give patients more control. Many jurors changed their opinion about who should get access to health records: 17 people became more willing to support wider information sharing of health data for public benefit, whereas 2 moved toward more patient control over patient records. CONCLUSIONS The findings highlight that, when informed of both risks and opportunities associated with data sharing, citizens believe an individual's right to privacy should not prevent research that can benefit the general public. The juries also concluded that patients should be notified of any such scheme and have the right to opt out if they so choose. Many jurors changed their minds about this complex policy question when they became more informed. Many, but not all, jurors became less skeptical about health data sharing, as they became better informed of its benefits and risks.
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Affiliation(s)
- Mary P Tully
- Health E-Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Sarah Clement
- Department of Geography and Planning, School of Environmental Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Amanda Hunn
- Health Research Authority, London, United Kingdom
| | - Lamiece Hassan
- Health E-Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ruth Norris
- Health E-Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Malcolm Oswald
- School of Law, Faculty of Humanities, The University of Manchester, Manchester, United Kingdom.,Citizens Juries Community Interest Company, Manchester, United Kingdom
| | - Niels Peek
- Health E-Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Rastogi S. Assessing the Ayurvedic prescribing trends on the basis of WHO drug use indicators. J Ayurveda Integr Med 2017; 10:12-17. [PMID: 29108945 PMCID: PMC6470269 DOI: 10.1016/j.jaim.2017.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/11/2017] [Accepted: 06/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background Ayurvedic prescriptions are often challenged for their rationality. Excessive use of proprietary medicines, rasa preparations, and samshodhana without any justification and deliverable benefits outweighing the other forms of safer, cheaper and less time consuming therapies is putting the Ayurvedic prescribing trends into question. In Ayurvedic practice, prescriptions are often individualized with substantial variability between the choices of drugs. Although being welcomed as an advanced approach of prescription writing by making it tailor made, this method also allows for lapses to creep in thus making it necessary to check common trends of prescribing in Ayurveda and to see whether it raises any caution. Objectives The objective of this study was to create a check for common trends of prescribing in Ayurveda and to see if such checks raise any caution. Materials and methods Present study utilizes the WHO drug use indicators as a preliminary tool for analyzing Ayurvedic prescriptions. Results It was found that with a small modification, this tool can help immensely in screening of Ayurvedic prescriptions. Conclusion Based on the results obtained through this study, it can be concluded that the WHO drug use indicators, with a small modification, can help in identifying the prescribing trends in Ayurveda and can also help in suggesting remedial measures in case certain anomalies are found.
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Abstract
OBJECTIVE To compare the prevalence of common mental disorders (CMDs) derived from data held in primary care records with that measured using the revised Clinical Interview Schedule (CIS-R) in order to assess the potential robustness of findings based only on routinely collected data. DESIGN AND SETTING Comparison study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic primary care records. PARTICIPANTS We studied 1562 adolescents who had completed the CIS-R in ALSPAC at age 17-18 years and had linkage established to their primary care records. OUTCOME MEASURES Outcome measures from ALSPAC were whether or not an individual met International Classification of Diseases-10 criteria for a diagnosis of (1) a CMD or, specifically, (2) depression. Lists of Read codes corresponding to diagnoses, symptoms and treatments were used to create 12 definitions of CMD and depression alone using the primary care data. We calculated sensitivities and specificities of these, using CIS-R definitions as the reference standard. RESULTS Sensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD.For both outcomes, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of CIS-R cases. CONCLUSIONS Most individuals meeting case definitions for CMD based on primary care data also met CIS-R case definitions. Conversely many individuals identified as cases using the CIS-R had no evidence of CMD in their clinical records. This suggests that clinical databases are likely to yield underestimates of the burden of CMD in the population. However, clinical records appear to yield valid diagnoses which may be useful for studying risk factors and consequences of CMD. The greatest epidemiological value may be obtained when information is available from survey and clinical records.
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Affiliation(s)
- Rosie P Cornish
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, UK
- Public Health Wales NHS Trust, Wales, UK
| | - Andy Boyd
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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John A, Marchant AL, Fone DL, McGregor JI, Dennis MS, Tan JOA, Lloyd K. Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study. Psychol Med 2016; 46:3315-3327. [PMID: 27879187 PMCID: PMC5122314 DOI: 10.1017/s0033291716002099] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP. METHOD This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored. RESULTS 3 58 383 registered patients aged 6-18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain. CONCLUSION Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.
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Affiliation(s)
- A. John
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - A. L. Marchant
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - D. L. Fone
- Division of Population Medicine,
School of Medicine, Cardiff University,
Cardiff, UK
| | - J. I. McGregor
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - M. S. Dennis
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - J. O. A. Tan
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - K. Lloyd
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
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Abstract
PURPOSE 'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS A narrative review. RESULTS Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.
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Affiliation(s)
- Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK.
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK
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