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Lo RF, Schumacher A, LaForge-Mackenzie K, Cost KT, Crosbie J, Charach A, Anagnostou E, Birken CS, Monga S, Korczak DJ. Evaluation of an automated matching system of children and families to virtual mental health resources during COVID-19. Child Adolesc Psychiatry Ment Health 2024; 18:24. [PMID: 38336708 PMCID: PMC10858567 DOI: 10.1186/s13034-024-00716-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Children and their families often face obstacles in accessing mental health (MH) services. The purpose of this study was to develop and pilot test an electronic matching process to match children with virtual MH resources and increase access to treatment for children and their families during COVID-19. METHODS Within a large observational child cohort, a random sample of 292 families with children ages 6-12 years were invited to participate. Latent profile analysis indicated five MH profiles using parent-reported symptom scores from validated depression, anxiety, hyperactivity, and inattention measures: (1) Average Symptoms, (2) Low Symptoms, (3) High Symptoms, (4) Internalizing, and (5) Externalizing. Children were matched with virtual MH resources according to their profile; parents received surveys at Time 1 (matching process explanation), Time 2 (match delivery) and Time 3 (resource uptake). Data on demographics, parent MH history, and process interest were collected. RESULTS 128/292 families (44%) completed surveys at Time 1, 80/128 families (63%) at Time 2, and a final 67/80 families (84%) at Time 3, yielding an overall uptake of 67/292 (23%). Families of European-descent and those with children assigned to the Low Symptoms profile were most likely to express interest in the process. No other factors were associated with continued interest or uptake of the electronic matching process. Most participating parents were satisfied with the process. CONCLUSIONS The electronic matching process delivered virtual MH resources to families in a time-efficient manner. Further research examining the effectiveness of electronically matched resources in improving children's MH symptoms is needed.
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Affiliation(s)
- Ronda F Lo
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Anett Schumacher
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Kaitlyn LaForge-Mackenzie
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Katherine Tombeau Cost
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Alice Charach
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daphne J Korczak
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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2
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Wang R, Monga S. Practical Tips for Paediatricians: Helping kids find their voices in selective mutism. Paediatr Child Health 2024; 29:7-9. [PMID: 38332978 PMCID: PMC10848117 DOI: 10.1093/pch/pxad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/10/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Rebecca Wang
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, University of Toronto, Toronto, Canada
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3
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Courtney DB, Iseyas N, Monga S, Butcher NJ, Krause KR, Besa R, Szatmari P. Systematic Review: The Measurement Properties of the Suicidal Ideation Questionnaire and Suicidal Ideation Questionnaire-Jr. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02264-5. [PMID: 38154613 DOI: 10.1016/j.jaac.2023.10.013] [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: 06/13/2023] [Revised: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE The Suicidal Ideation Questionnaire (SIQ) and the Suicidal Ideation Questionnaire-Junior (SIQ-Jr) were designed to capture suicidal ideation in adolescents and are often used in clinical trials. Our aim was to identify and appraise the published literature with respect to the validity, reliability, responsiveness, and interpretability of the SIQ and SIQ-Jr. METHOD We conducted a systematic review following COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines to identify, appraise, and synthesize published literature on measurement properties and interpretability of the SIQ and SIQ-Jr. We searched MEDLINE, Embase, APA PsycINFO, CINAHL, Web of Science, and Scopus from inception to May 16, 2023, to identify sources relevant to our aim. RESULTS We identified 15 sources meeting our eligibility criteria. The body of literature did not meet COSMIN standards to make recommendations for use with regard to these measurement instruments. CONCLUSION Further research is needed, with a focus on content validity and structural validity, prior to recommending the SIQ and SIQ-Jr for use in clinical practice and in clinical trials. No specific grant funding was used for this review.
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Affiliation(s)
| | | | | | | | - Karolin R Krause
- Cundill Centre for Child and Youth Depression, Toronto, Ontario, Canada
| | - Reena Besa
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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4
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Park C, Tsujimoto KC, Cost KT, Anagnostou E, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiadis S, Burton C, Crosbie J, Korczak DJ. The Distinction Between Social Connectedness and Support When Examining Depressive Symptoms Among Children and Adolescents During the COVID-19 Pandemic. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01616-8. [PMID: 37934336 DOI: 10.1007/s10578-023-01616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
Childhood depression is associated with significant social and functional impairment, suicide risk, and persistence throughout adulthood. Recent evidence demonstrates that social connectedness and social support may serve as protective factors against the development of depression. The current study aimed to examine the effect of change in social connectedness and social support on depressive symptoms among children and adolescents during the COVID-19 pandemic. Hierarchical regression was performed. Results indicated that parent-reported measures of change in social connectedness were inversely associated with depressive symptom severity, and could significantly predict future depressive symptom severity. In contrast, parent-reported measures of social support (i.e., from family and friends) did not significantly predict future depressive symptom severity. The presence of a pre-COVID psychiatric and/or neurodevelopmental diagnosis and baseline depressive symptom severity were also important factors associated with future depressive symptom severity. The findings suggest that an awareness of the presence of social supports (i.e., family or friends) is not sufficient for children to feel connected, but rather the mechanisms of social relationships are crucial. As our approach to public health restrictions evolves, the risk transmission of COVID-19 should be carefully balanced with the risks associated with decreased connectedness among youth.
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Affiliation(s)
- Caroline Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Holland Bloorview Research Institute, Toronto, ON, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Kelley
- Departments of Psychology and Psychiatry, Queens University, Kingston, ON, Canada
| | - Rob Nicolson
- Department of Child and Adolescent Psychiatry, University of Western, London, ON, Canada
| | - Stelios Georgiadis
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christie Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Cost KT, Mudiyanselage P, Unternaehrer E, Korczak DJ, Crosbie J, Anagnastou E, Monga S, Kelley E, Schachar R, Maguire J, Arnold P, Burton CL, Georgiades S, Nicolson R, Birken CS, Charach A. The role of parenting practices in parent and child mental health over time. BJPsych Open 2023; 9:e147. [PMID: 37550865 PMCID: PMC10594096 DOI: 10.1192/bjo.2023.529] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Parent and child mental health has suffered during the pandemic and transition phase. Structured and shared parenting may be intervention targets beneficial to families who are struggling with parent or child mental health challenges. AIMS First, we investigated associations between structured and shared parenting and parent depression symptoms. Second, we investigated associations between structured and shared parenting and depression, hyperactivity/inattention and irritability symptoms in children. METHOD A total of 1027 parents in two-parent households (4797 observations total; 85.1% mothers) completed online surveys about themselves and their children (aged 2-18 years) from April 2020 to July 2022. Structured parenting and shared parenting responsibilities were assessed from April 2020 to November 2021. Symptoms of parent depression, child depression, child hyperactivity and inattention, child irritability, and child emotional and conduct problems were assessed repeatedly (one to 14 times; median of four times) from April 2020 to July 2022. RESULTS Parents who reported higher levels of shared parenting responsibilities had lower depression symptoms (β = -0.09 to -0.32, all P < 0.01) longitudinally. Parents who reported higher levels of shared parenting responsibilities had children with fewer emotional problems (ages 2-5 years; β = -0.07, P < 0.05), fewer conduct problems (ages 2-5 years; β = -0.09, P < 0.01) and less irritability (ages 13-18 years; β = -0.27, P < 0.001) longitudinally. Structured parenting was associated with fewer conduct problems (ages 2-5 years; β = -0.05, P < 0.05). CONCLUSIONS Shared parenting is beneficial for parent and child mental health, even under chaotic or inflexible life conditions. Structured parenting is beneficial for younger children.
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Affiliation(s)
- Katherine T. Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Behavioural Neurosciences & Psychiatry, McMaster University, Canada
| | - Piyumi Mudiyanselage
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, Canada
| | - Eva Unternaehrer
- University Psychiatric Clinics Basel, University of Basel, Switzerland
| | - Daphne J. Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Evdokia Anagnastou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Canada; and Department of Psychiatry, Queen's University, Canada
| | - Russell Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Jonathon Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry and Medical Genetics, Cumming School of Medicine, University of Calgary, Canada
| | | | - Stelios Georgiades
- Department of Behavioural Neurosciences & Psychiatry, McMaster University, Canada
| | - Rob Nicolson
- Department of Psychiatry, University of Western Ontario, Canada
| | - Catherine S. Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
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6
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Bobbitt S, Kawamura A, Saunders N, Monga S, Penner M, Andrews D. L’anxiété chez les enfants et les adolescents – partie 2 : la prise en charge des troubles anxieux. Paediatr Child Health 2023. [PMCID: PMC9971578 DOI: 10.1093/pch/pxac103] [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] [Indexed: 03/04/2023] Open
Abstract
Les troubles anxieux sont les problèmes de santé mentale les plus courants chez les enfants et les adolescents canadiens. La Société canadienne de pédiatrie a préparé deux documents de principes qui résument les données probantes à jour sur leur diagnostic et leur prise en charge. Ces documents contiennent des conseils fondés sur des données probantes afin d’aider les professionnels de la santé à prendre des décisions à l’égard des soins aux enfants et aux adolescents atteints de ces troubles. La deuxième partie, qui porte sur la prise en charge, vise à 1) passer en revue les données probantes et le contexte de diverses approches cliniques qui combinent des interventions comportementales et pharmacologiques pour traiter les atteintes de façon appropriée; 2) décrire le rôle de l’éducation et de la psychothérapie pour la prévention et le traitement des troubles anxieux; 3) décrire l’utilisation de la pharmacothérapie, y compris les effets secondaires et les risques qui s’y rapportent. Les recommandations sur la prise en charge de l’anxiété reposent sur les lignes directrices à jour, une analyse bibliographique et un consensus d’experts. Il est à souligner que, dans le présent document, le terme « parent » (au singulier ou au pluriel) inclut les personnes qui s’occupent principalement de l’enfant et toutes les configurations familiales.
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Affiliation(s)
- Susan Bobbitt
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
| | - Anne Kawamura
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
| | - Natasha Saunders
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
| | - Suneeta Monga
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
| | - Melanie Penner
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
| | - Debra Andrews
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)Canada
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7
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Vibert B, Segura P, Gallagher L, Georgiades S, Pervanidou P, Thurm A, Alexander L, Anagnostou E, Aoki Y, Birken CS, Bishop SL, Boi J, Bravaccio C, Brentani H, Canevini P, Carta A, Charach A, Costantino A, Cost KT, Cravo EA, Crosbie J, Davico C, Donno F, Fujino J, Gabellone A, Geyer CT, Hirota T, Kanne S, Kawashima M, Kelley E, Kim H, Kim YS, Kim SH, Korczak DJ, Lai MC, Margari L, Marzulli L, Masi G, Mazzone L, McGrath J, Monga S, Morosini P, Nakajima S, Narzisi A, Nicolson R, Nikolaidis A, Noda Y, Nowell K, Polizzi M, Portolese J, Riccio MP, Saito M, Schwartz I, Simhal AK, Siracusano M, Sotgiu S, Stroud J, Sumiya F, Tachibana Y, Takahashi N, Takahashi R, Tamon H, Tancredi R, Vitiello B, Zuddas A, Leventhal B, Merikangas K, Milham MP, Di Martino A. CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions. Mol Autism 2023; 14:7. [PMID: 36788583 PMCID: PMC9928142 DOI: 10.1186/s13229-022-00536-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/26/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. METHODS Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. RESULTS Clustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. LIMITATIONS Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. CONCLUSIONS Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.
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Affiliation(s)
- Bethany Vibert
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Patricia Segura
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Louise Gallagher
- grid.8217.c0000 0004 1936 9705Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stelios Georgiades
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National & Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Audrey Thurm
- grid.416868.50000 0004 0464 0574Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD USA
| | - Lindsay Alexander
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA
| | - Evdokia Anagnostou
- grid.414294.e0000 0004 0572 4702Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Paediatrics, University of Toronto, Toronto, ON Canada
| | - Yuta Aoki
- grid.410714.70000 0000 8864 3422Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
| | - Catherine S. Birken
- grid.17063.330000 0001 2157 2938Department of Pediatrics, School of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON Canada
| | - Somer L. Bishop
- grid.266102.10000 0001 2297 6811Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA USA
| | - Jessica Boi
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Carmela Bravaccio
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Helena Brentani
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Paola Canevini
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy ,grid.415093.a0000 0004 1793 3800Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo E Carlo, San Paolo Hospital, Milan, Italy
| | - Alessandra Carta
- Department of Medical, Surgical and Pharmacy, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Italy
| | - Alice Charach
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Antonella Costantino
- grid.414818.00000 0004 1757 8749Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Katherine T. Cost
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada
| | - Elaine A Cravo
- grid.20736.300000 0001 1941 472XUFPR - Federal University of Paraná, Paraná, Brazil
| | - Jennifer Crosbie
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Chiara Davico
- grid.7605.40000 0001 2336 6580Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Federica Donno
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Junya Fujino
- grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Alessandra Gabellone
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Cristiane T Geyer
- grid.20736.300000 0001 1941 472XUFPR - Federal University of Paraná, Paraná, Brazil
| | - Tomoya Hirota
- grid.266102.10000 0001 2297 6811Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA USA ,grid.257016.70000 0001 0673 6172Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Stephen Kanne
- grid.5386.8000000041936877XDepartment of Psychiatry, Weill Cornell Medical College, Center for Autism and the Developing Brain, New York, NY USA
| | | | - Elizabeth Kelley
- grid.410356.50000 0004 1936 8331Department of Psychology, Queens University, Kingston, ON Canada
| | - Hosanna Kim
- grid.266102.10000 0001 2297 6811The UCSF Center for ASD & NDDs, University of California San Francisco, San Francisco, CA USA
| | - Young Shin Kim
- grid.266102.10000 0001 2297 6811The UCSF Center for ASD & NDDs, University of California San Francisco, San Francisco, CA USA
| | - So Hyun Kim
- grid.222754.40000 0001 0840 2678School of Psychology and Psychiatry, Korea University, Seoul, South Korea
| | - Daphne J. Korczak
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Meng-Chuan Lai
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lucia Margari
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Lucia Marzulli
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Gabriele Masi
- IRCCS Stella Maris Foundation, Calambrone-Pisa, Italy
| | - Luigi Mazzone
- grid.6530.00000 0001 2300 0941Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Jane McGrath
- grid.8217.c0000 0004 1936 9705Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland ,39ADMiRE, Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital, Ballyfermot, Dublin, Ireland
| | - Suneeta Monga
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Paola Morosini
- Unita’ Operativa di Neuropsichiatria dell’ Infanzia e dell’ adolescenza, Lodi, Italy
| | - Shinichiro Nakajima
- grid.26091.3c0000 0004 1936 9959Keio University School of Medicine, Tokyo, Japan
| | | | - Rob Nicolson
- grid.39381.300000 0004 1936 8884Department of Psychiatry, University of Western Ontario, London, ON Canada
| | - Aki Nikolaidis
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA
| | - Yoshihiro Noda
- grid.26091.3c0000 0004 1936 9959Keio University School of Medicine, Tokyo, Japan
| | - Kerri Nowell
- grid.134936.a0000 0001 2162 3504Thompson Center of Neurodevelopmental Disorders, University of Missouri, Columbia, MO USA
| | - Miriam Polizzi
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Joana Portolese
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Maria Pia Riccio
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Manabu Saito
- grid.257016.70000 0001 0673 6172Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan ,grid.257016.70000 0001 0673 6172Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan ,grid.257016.70000 0001 0673 6172Department of Clinical Psychological Science, Comprehensive Rehabilitation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - Ida Schwartz
- grid.8532.c0000 0001 2200 7498Genetics Department/UFRGS, Medical Genetics Service/HCPA, Porto Alegre, Brazil
| | - Anish K. Simhal
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA ,grid.51462.340000 0001 2171 9952Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Martina Siracusano
- grid.6530.00000 0001 2300 0941Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Sotgiu
- Department of Medical, Surgical and Pharmacy, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Italy
| | - Jacob Stroud
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Fernando Sumiya
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Yoshiyuki Tachibana
- grid.63906.3a0000 0004 0377 2305Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nicole Takahashi
- grid.134936.a0000 0001 2162 3504Thompson Center of Neurodevelopmental Disorders, University of Missouri, Columbia, MO USA
| | | | - Hiroki Tamon
- grid.63906.3a0000 0004 0377 2305Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Alessandro Zuddas
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy ,Child & Adolescent Neuropsychiatry Unit, “A.Cao” Paediatric Hospital, Cagliari, Italy
| | - Bennett Leventhal
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL USA
| | - Kathleen Merikangas
- grid.416868.50000 0004 0464 0574Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Michael P. Milham
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Adriana Di Martino
- Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY, USA.
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8
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Prebeg M, Patton M, Desai R, Smith M, Krause K, Butcher N, Monga S. From participants to partners: reconceptualising authentic patient engagement roles in youth mental health research. Lancet Psychiatry 2023; 10:139-145. [PMID: 36502816 DOI: 10.1016/s2215-0366(22)00377-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022]
Abstract
The value of involving people with lived experience in the research process (ie, patient engagement) is increasingly being recognised within youth mental health research. The wide-reaching benefits of patient engagement have been documented in the literature, including the empowerment of patients, improvement of research outcomes, and increased relevance of research findings. Although various models exist to guide patient engagement, there are key concepts that deserve exploration to ensure the authentic implementation of these models and development of patient roles. Our Personal View aims to: identify and discuss barriers to patient engagement roles in the context of youth mental health research; consider how key concepts of relational empowerment, fluidity, and flexibility can address some of these barriers; and provide tangible recommendations for implementing authentic patient engagement throughout the research process.
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Affiliation(s)
- Matthew Prebeg
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Margaret & Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Patton
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Riddhi Desai
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Karolin Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada.
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9
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Bobbitt S, Kawamura A, Saunders N, Monga S, Penner M, Andrews D. Anxiety in children and youth: Part 2-The management of anxiety disorders. Paediatr Child Health 2023; 28:52-66. [PMID: 36865757 PMCID: PMC9971334 DOI: 10.1093/pch/pxac104] [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: 04/01/2021] [Accepted: 04/12/2022] [Indexed: 03/04/2023] Open
Abstract
Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.
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Affiliation(s)
- Susan Bobbitt
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Anne Kawamura
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Natasha Saunders
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Suneeta Monga
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Melanie Penner
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Debra Andrews
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
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10
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Butcher NJ, Monsour A, Mew EJ, Chan AW, Moher D, Mayo-Wilson E, Terwee CB, Chee-A-Tow A, Baba A, Gavin F, Grimshaw JM, Kelly LE, Saeed L, Thabane L, Askie L, Smith M, Farid-Kapadia M, Williamson PR, Szatmari P, Tugwell P, Golub RM, Monga S, Vohra S, Marlin S, Ungar WJ, Offringa M. Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension. JAMA 2022; 328:2345-2356. [PMID: 36512367 DOI: 10.1001/jama.2022.21243] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Complete information in a trial protocol regarding study outcomes is crucial for obtaining regulatory approvals, ensuring standardized trial conduct, reducing research waste, and providing transparency of methods to facilitate trial replication, critical appraisal, accurate reporting and interpretation of trial results, and knowledge synthesis. However, recommendations on what outcome-specific information should be included are diverse and inconsistent. To improve reporting practices promoting transparent and reproducible outcome selection, assessment, and analysis, a need for specific and harmonized guidance as to what outcome-specific information should be addressed in clinical trial protocols exists. OBJECTIVE To develop harmonized, evidence- and consensus-based standards for describing outcomes in clinical trial protocols through integration with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 statement. EVIDENCE REVIEW Using the Enhancing the Quality and Transparency of Health Research (EQUATOR) methodological framework, the SPIRIT-Outcomes 2022 extension of the SPIRIT 2013 statement was developed by (1) generation and evaluation of candidate outcome reporting items via consultation with experts and a scoping review of existing guidance for reporting trial outcomes (published within the 10 years prior to March 19, 2018) identified through expert solicitation, electronic database searches of MEDLINE and the Cochrane Methodology Register, gray literature searches, and reference list searches; (2) a 3-round international Delphi voting process (November 2018-February 2019) completed by 124 panelists from 22 countries to rate and identify additional items; and (3) an in-person consensus meeting (April 9-10, 2019) attended by 25 panelists to identify essential items for outcome-specific reporting to be addressed in clinical trial protocols. FINDINGS The scoping review and consultation with experts identified 108 recommendations relevant to outcome-specific reporting to be addressed in trial protocols, the majority (72%) of which were not included in the SPIRIT 2013 statement. All recommendations were consolidated into 56 items for Delphi voting; after the Delphi survey process, 19 items met criteria for further evaluation at the consensus meeting and possible inclusion in the SPIRIT-Outcomes 2022 extension. The discussions during and after the consensus meeting yielded 9 items that elaborate on the SPIRIT 2013 statement checklist items and are related to completely defining and justifying the choice of primary, secondary, and other outcomes (SPIRIT 2013 statement checklist item 12) prospectively in the trial protocol, defining and justifying the target difference between treatment groups for the primary outcome used in the sample size calculations (SPIRIT 2013 statement checklist item 14), describing the responsiveness of the study instruments used to assess the outcome and providing details on the outcome assessors (SPIRIT 2013 statement checklist item 18a), and describing any planned methods to account for multiplicity relating to the analyses or interpretation of the results (SPIRIT 2013 statement checklist item 20a). CONCLUSIONS AND RELEVANCE This SPIRIT-Outcomes 2022 extension of the SPIRIT 2013 statement provides 9 outcome-specific items that should be addressed in all trial protocols and may help increase trial utility, replicability, and transparency and may minimize the risk of selective nonreporting of trial results.
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Affiliation(s)
- Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Mayo-Wilson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Caroline B Terwee
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
- Department of Methodology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Frank Gavin
- public panel member, Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, England
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert M Golub
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunita Vohra
- Departments of Pediatrics and Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Susan Marlin
- Clinical Trials Ontario, Toronto, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Butcher NJ, Monsour A, Mew EJ, Chan AW, Moher D, Mayo-Wilson E, Terwee CB, Chee-A-Tow A, Baba A, Gavin F, Grimshaw JM, Kelly LE, Saeed L, Thabane L, Askie L, Smith M, Farid-Kapadia M, Williamson PR, Szatmari P, Tugwell P, Golub RM, Monga S, Vohra S, Marlin S, Ungar WJ, Offringa M. Guidelines for Reporting Outcomes in Trial Reports: The CONSORT-Outcomes 2022 Extension. JAMA 2022; 328:2252-2264. [PMID: 36511921 DOI: 10.1001/jama.2022.21022] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Clinicians, patients, and policy makers rely on published results from clinical trials to help make evidence-informed decisions. To critically evaluate and use trial results, readers require complete and transparent information regarding what was planned, done, and found. Specific and harmonized guidance as to what outcome-specific information should be reported in publications of clinical trials is needed to reduce deficient reporting practices that obscure issues with outcome selection, assessment, and analysis. OBJECTIVE To develop harmonized, evidence- and consensus-based standards for reporting outcomes in clinical trial reports through integration with the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement. EVIDENCE REVIEW Using the Enhancing the Quality and Transparency of Health Research (EQUATOR) methodological framework, the CONSORT-Outcomes 2022 extension of the CONSORT 2010 statement was developed by (1) generation and evaluation of candidate outcome reporting items via consultation with experts and a scoping review of existing guidance for reporting trial outcomes (published within the 10 years prior to March 19, 2018) identified through expert solicitation, electronic database searches of MEDLINE and the Cochrane Methodology Register, gray literature searches, and reference list searches; (2) a 3-round international Delphi voting process (November 2018-February 2019) completed by 124 panelists from 22 countries to rate and identify additional items; and (3) an in-person consensus meeting (April 9-10, 2019) attended by 25 panelists to identify essential items for the reporting of outcomes in clinical trial reports. FINDINGS The scoping review and consultation with experts identified 128 recommendations relevant to reporting outcomes in trial reports, the majority (83%) of which were not included in the CONSORT 2010 statement. All recommendations were consolidated into 64 items for Delphi voting; after the Delphi survey process, 30 items met criteria for further evaluation at the consensus meeting and possible inclusion in the CONSORT-Outcomes 2022 extension. The discussions during and after the consensus meeting yielded 17 items that elaborate on the CONSORT 2010 statement checklist items and are related to completely defining and justifying the trial outcomes, including how and when they were assessed (CONSORT 2010 statement checklist item 6a), defining and justifying the target difference between treatment groups during sample size calculations (CONSORT 2010 statement checklist item 7a), describing the statistical methods used to compare groups for the primary and secondary outcomes (CONSORT 2010 statement checklist item 12a), and describing the prespecified analyses and any outcome analyses not prespecified (CONSORT 2010 statement checklist item 18). CONCLUSIONS AND RELEVANCE This CONSORT-Outcomes 2022 extension of the CONSORT 2010 statement provides 17 outcome-specific items that should be addressed in all published clinical trial reports and may help increase trial utility, replicability, and transparency and may minimize the risk of selective nonreporting of trial results.
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Affiliation(s)
- Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Mayo-Wilson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Caroline B Terwee
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
- Department of Methodology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Frank Gavin
- public panel member, Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, England
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert M Golub
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunita Vohra
- Departments of Pediatrics and Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Susan Marlin
- Clinical Trials Ontario, Toronto, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Krause KR, Hetrick SE, Courtney DB, Cost KT, Butcher NJ, Offringa M, Monga S, Henderson J, Szatmari P. How much is enough? Considering minimally important change in youth mental health outcomes. Lancet Psychiatry 2022; 9:992-998. [PMID: 36403601 DOI: 10.1016/s2215-0366(22)00338-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sarah E Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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13
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Tsujimoto KC, Cost KT, LaForge-MacKenzie K, Anagnostou E, Birken CS, Charach A, Monga S, Kelly E, Nicolson R, Georgiadis S, Lee N, Osokin K, Arnold P, Schachar R, Burton C, Crosbie J, Korczak DJ. School and learning contexts during the COVID-19 pandemic: Implications for child and youth mental health. Curr Psychol 2022; 42:1-17. [PMID: 36468159 PMCID: PMC9685153 DOI: 10.1007/s12144-022-03941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Accepted: 10/26/2022] [Indexed: 11/25/2022]
Abstract
Despite significant disruption to school during the COVID-19 pandemic, research on the impact on children is sparse. This study examines in-person and virtual learning contexts and the impact of school format on mental health (MH). Children and adolescents were recruited from community and clinical settings. Parents and children completed prospective online surveys about school experiences (November 2020) and MH symptoms (February/March 2021), including school format and activities. Standardized measures of depression, anxiety, inattention, and hyperactivity were collected. Hierarchical regression analyses tested associations between school format and MH. Children (N = 1011; aged 6-18 years) attending school in-person (n = 549) engaged in high levels of participation in COVID-19 health measures and low levels of social learning activities. Learning online in high school was associated with greater MH symptoms (B = -2.22, CI[-4.32,-.12] to B = -8.18, CI[-15.59,-.77]). Children with no previous MH condition that attended school virtually experienced a similar magnitude of MH symptoms as those with previous MH conditions. However, children who attended school in a hybrid in-person format, with no previous MH condition, experienced less hyperactivity as same-age peers with prior MH problems (B = -8.08, CI[1.58,14.58]). Children's learning environments looked very different compared to before the pandemic. Removing children from school environments and limiting opportunities that support their MH, such as social learning activities, is problematic. Efforts to address the learning contexts to protect the mental health of children are needed.
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Affiliation(s)
- Kimberley C. Tsujimoto
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Katherine Tombeau Cost
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Kaitlyn LaForge-MacKenzie
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Evdokia Anagnostou
- Deprtment of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Holland Bloorview Research Institute, Toronto, ON Canada
| | - Catherine S. Birken
- Deprtment of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Elizabeth Kelly
- Departments of Psychology and Psychiatry, Queens University, Kingston, ON Canada
| | - Rob Nicolson
- Department of Child and Adolescent Psychiatry, University of Western Ontario, London, ON Canada
| | - Stelios Georgiadis
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Nicole Lee
- Toronto District School Board, Toronto, ON Canada
| | | | - Paul Arnold
- Department of Psychiatry, University of Calgary, AB Calgary, Canada
- Department Medical Genetics, University of Calgary, AB Calgary, Canada
| | - Russell Schachar
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Christie Burton
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Daphne J. Korczak
- Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
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14
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Shetty J, Perquier F, Campisi SC, Wasan Y, Aitken M, Korczak DJ, Monga S, Soofi SB, Szatmari P, Bhutta ZA. Psychometric properties of the Sindhi version of the Mood and Feelings Questionnaire (MFQ) in a sample of early adolescents living in rural Pakistan. PLOS Glob Public Health 2022; 2:e0000968. [PMID: 36962610 PMCID: PMC10021798 DOI: 10.1371/journal.pgph.0000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
There is a need for reliable and valid screening tools that assess depressive symptoms in adolescents in Pakistan. To address this need, the present study examined the psychometric properties and factor structure of a Sindhi-translated and adapted version of the child-report Mood and Feelings Questionnaire (MFQ-C) and the Short Mood and Feelings Questionnaire (SMFQ-C) in a community sample of adolescents living in Matiari, Pakistan. Questionnaires were translated into Sindhi and administered by study psychologists to 1350 participants (52.3% female) 9.0 to 15.9 years old. Measurement structure was examined using confirmatory factor analysis. Internal consistency was estimated, and convergent and divergent validity were explored using subscales from the Strengths and Difficulties Questionnaire and the Screen for Child Anxiety Related Emotional Disorders. The unidimensional structure of the MFQ-C was found to be adequate, but a four-factor structure comprising core mood, vegetative, cognitive and agitated distress symptoms best fit the data (CFI = 0.97, TLI = 0.97, RMSEA = 0.05). The original unidimensional structure of the SMFQ-C was supported (CFI = 0.97, TLI = 0.96, RMSEA = 0.07). The MFQ-C and the SMFQ-C respectively showed excellent (α = 0.92) and good internal consistency (α = 0.87) as well as satisfactory construct validity with some differences observed across the MFQ-C subscales. The SMFQ-C and the adapted MFQ-C appear to be reliable and valid measures of depressive symptoms among early adolescents living in rural Pakistan. Both total and subscale scores can be derived from the MFQ-C to assess general and specific dimensions of depressive symptoms in this population.
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Affiliation(s)
- Janavi Shetty
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Florence Perquier
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susan C. Campisi
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Global Child Health; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health; Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
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15
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Patton MC, Desai R, Noureddine Y, Prebeg MJ, Krause KR, Vohra S, Butcher NJ, Monga S. Outcomes and outcome measurement instruments reported in randomised controlled trials of anxiety disorder treatments in children and adolescents: a scoping review protocol. BMJ Open 2022; 12:e063404. [PMID: 36207041 PMCID: PMC9558797 DOI: 10.1136/bmjopen-2022-063404] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Paediatric anxiety disorders (AD) are prevalent and persistent mental health conditions worldwide affecting between 10% and 20% of children and adolescents. Despite the high prevalence of paediatric AD, there is limited understanding of which treatments work best. Outcome heterogeneity across paediatric mental health trials has been a significant factor in hindering the ability to compare results and assess the efficacy of such trials. This scoping review will help to identify and synthesise the outcomes reported in paediatric AD trials to date. METHODS AND ANALYSIS Following the Joanna Briggs Institute scoping review methodology, a comprehensive electronic bibliographic database search (MEDLINE, APA PsycINFO, Embase, CINAHL) strategy will be applied to identify articles examining interventions for children diagnosed with an AD. Articles will be eligible for inclusion if they assess at least one AD intervention (eg, psychological), in children 4-18 years of age inclusive. Initial title and abstract screening will be completed by two trained reviewers independently and in duplicate. Full-text screening of each included article will be completed independently and in duplicate by two of three trained reviewers. Identified outcomes will be mapped to a standard outcome taxonomy developed for core outcome sets. Trial and outcome characteristics will be synthesised using quantitative metrics (counts and frequencies). ETHICS AND DISSEMINATION As this is a scoping review of the literature and patient information or records were not accessed, institutional ethics approval was not required. Results of this scoping review will be disseminated to clinicians, researchers inclusive of trialists and other stakeholders invested in outcome selection, measurement and reporting in paediatric AD trials. In addition, scoping review results will inform the development of a Core Outcome Set for paediatric AD trials-a minimum set of outcomes that should be measured across trials in an area of health, without precluding the inclusion of other outcomes.
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Affiliation(s)
- Megan C Patton
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Riddhi Desai
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yasmine Noureddine
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthew J Prebeg
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karolin Rose Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Educational and Health Psychology, University College London, London, UK
| | - Sunita Vohra
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Monga S, Valkovic L, Mahmod M, Myerson SG, Neubauer S, Rider OJ. Characterisation of metabolic phenotype in aortic stenosis: insights from a multi-parametric cardiac magnetic resonance study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1618] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left ventricular hypertrophy develops in Aortic stenosis (AS) as a result of increased afterload and is related to perturbations in cardiac fatty acid metabolism with evidence of steatosis and impaired myocardial energetics in severe AS. However, there is wide individual heterogeneity when it comes to degree of hypertrophy and progression to myocardial fibrosis and heart failure in those with same degree of stenosis. Underlying interplay of metabolism and hypertrophy may explain this variability.
Purpose
We sought to determine if a gradient of myocardial energetic impairment and steatosis exists across the spectrum of AS and precedes irreversible structural remodelling and subclinical LV dysfunction. We investigated metabolic remodelling in AS, focusing on its relationship with stenosis severity, degree of hypertrophy and fibrosis.
Methods
74 AS participants including mild AS (n=18), asymptomatic moderate AS (n=38), asymptomatic severe AS (n=18), and healthy volunteers (n=13) underwent assessment of cardiac function, energetics (myocardial phosphocreatine to adenosine triphosphate ratio, PCr/ATP) and myocardial triglyceride content (MTG) using cardiovascular magnetic resonance (CMR) imaging and spectroscopy. Participants were divided into quartile groups based on their LV wall thickness (LVWT) and peak aortic valve gradient (AVG) to study relationship between cardiac metabolism and hemodynamic markers of LV structure and function.
Results
Baseline CMR characteristics (Fig. 1B-C) show a stepwise deterioration in LV structure and function across both the LVWT and AVG quartile groups (p values significant) with high LV mass index and relatively dilated LV as disease severity increases.
Cardiac energetics (PCr/ATP]) were reduced in mild-moderate AS, Q2 (1.43±0.13 vs normal controls, Q1 1.80±0.14, p=0.05, Fig.2A) with a progressive decline with increasing AS severity (severe AS, Q4 PCr/ATP 1.39±0.14, p=0.02 vs controls). MTG was elevated in mild-moderate AS, Q2 (1.52±0.84 vs normal, Q1 1.25±0.70%, p=0.032, Fig. 2B). Whilst all AS groups had evidence of subclinical LV dysfunction with impaired strain parameters, impaired systolic longitudinal strain was related to the degree of energetic impairment (R 0.219, p 0.03). In addition, PCr/ATP was strongly associated with the presence of myocardial fibrosis (p 0.01) strengthening the hypothesis that metabolic changes may play a causative role in disease progression (Fig. 2C).
Conclusion
A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, notably we show in our study that these metabolic changes precede irreversible LV remodelling and subclinical dysfunction. These findings may have value for defining distinct metabolic phenotypes and identifying those most at risk of decompensation. This also opens another avenue for precision metabolic therapy in AS with a potential to intervene and delay or prevent decompensation.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- S Monga
- University of Oxford , Oxford , United Kingdom
| | - L Valkovic
- University of Oxford , Oxford , United Kingdom
| | - M Mahmod
- University of Oxford , Oxford , United Kingdom
| | - S G Myerson
- University of Oxford , Oxford , United Kingdom
| | - S Neubauer
- University of Oxford , Oxford , United Kingdom
| | - O J Rider
- University of Oxford , Oxford , United Kingdom
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17
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Les profils de santé mentale des enfants et adolescents autistes pendant la pandémie de COVID-19. Paediatr Child Health 2022; 27:S143-S150. [PMID: 36092298 PMCID: PMC9455656 DOI: 10.1093/pch/pxac016] [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: 08/10/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectifs Les confinements dans les provinces canadiennes ont malmené la santé mentale des enfants pendant la pandémie de COVID-19, et les enfants autistes y ont été particulièrement vulnérables. La présente étude visait à recenser les sous-groupes d’enfants autistes ayant des profils distincts de modification à leur santé mentale, afin de comprendre les facteurs propres aux enfants, aux parents et au système qui y sont associés et d’éclairer de futures interventions. Méthodologie Les chercheurs ont extrait les données d’une vaste cohorte ontarienne (n=1 570), dont faisaient partie 265 enfants autistes (âge moyen=10,9 ans, 76 % de sexe masculin). Ils ont utilisé l’analyse des nuées dynamiques pour répartir les profils de santé mentale distincts en six mesures (humeur, anxiété, symptômes de trouble obsessionnel-compulsif, irritabilité, inattention, hyperactivité) et ont examiné les différences entre les groupes. Ils ont également étudié les caractéristiques des enfants qui ont accédé à des services aigus en santé mentale. Résultats Le nombre optimal de grappes était fixé à deux. La première incluait ceux qui avaient éprouvé une détérioration de leur santé mentale dans les six mesures (61,3 %, intervalle de confiance à 95 %=54,9 à 67,4) et la seconde, les jeunes dont la santé mentale n’avait pas changé (38,7 %, intervalle de confiance à 95 %=32,6 à 45,1). Des facteurs étaient associés à la détérioration de la santé mentale des enfants : plus de symptômes internalisés préexistants et de forts taux de stress liés à la COVID-19. Les problèmes de santé mentale des parents et les facteurs propres aux systèmes, tels que la perte de soutien à l’apprentissage, l’accès aux médecins et les difficultés matérielles, étaient aussi liés à cette détérioration. L’accès à des services aigus en santé mentale découlait d’abord de l’insécurité financière et de la perte de services. Conclusions Plus de la moitié des enfants autistes ont éprouvé une détérioration de leur santé mentale, et les caractéristiques individuelles (troubles de santé mentale préexistants, stress lié à la COVID-19), parentales (santé mentale des parents) et systémiques (perte de services et difficultés matérielles) y étaient reliées, ce qui ouvrait la voie à des interventions cliniques et politiques multiniveaux.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Daphne J Korczak
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Katherine T Cost
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jennifer Crosbie
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Catherine S Birken
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
| | - Alice Charach
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
- Institut des politiques, de la gestion et de l’évaluation de la santé, faculté de médecine Temerty, Université de Toronto, Toronto (Ontario)Canada
| | - Suneeta Monga
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Elizabeth Kelley
- Département de psychologie, Université Queen’s, Kingston (Ontario)Canada
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Rob Nicolson
- Département de psychiatrie, Université Western, London (Ontario)Canada
| | - Stelios Georgiades
- Département de psychiatrie et de neurosciences comportementales, Université McMaster, Hamilton (Ontario)Canada
| | - Muhammad Ayub
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Russell J Schachar
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
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18
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LaForge-MacKenzie K, Tombeau Cost K, Tsujimoto KC, Crosbie J, Charach A, Anagnostou E, Birken CS, Monga S, Kelley E, Burton CL, Nicolson R, Georgiades S, Korczak DJ. Participating in extracurricular activities and school sports during the COVID-19 pandemic: Associations with child and youth mental health. Front Sports Act Living 2022; 4:936041. [PMID: 36105001 PMCID: PMC9464933 DOI: 10.3389/fspor.2022.936041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
In Ontario, Canada, school extracurricular activities and sports were modified or canceled for a prolonged period due to public health restrictions resulting from the COVID-19 pandemic. The present study aims to examine the association of changes to extracurricular and sport participation and child and youth mental health. Data were collected on child and youth mental health symptoms (n = 908) and participation in extracurricular activities and sports in the 2019–2020 and 2020–2021 academic years. Results indicated that pre-COVID (2019–2020) participation in either extracurricular activities or sports was associated with reduced anxiety, inattention, and hyperactivity during the pandemic (β range −0.08 to −0.11, p < 0.05). Participation in either extracurricular activities or sports during-COVID (2020–2021) was associated with lower depressive symptoms (β range −0.09 to −0.10, p < 0.05). Findings suggest that participation in extracurricular activities and/or school sports both before or during the COVID-19 pandemic were associated with better mental health outcomes in children and youth. Implications of this work consider future situations where restrictions on extracurricular and sport participation are reinstated and the impact of child and youth mental health.
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Affiliation(s)
- Kaitlyn LaForge-MacKenzie
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Katherine Tombeau Cost
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Kimberley C. Tsujimoto
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alice Charach
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Holland Bloorview Research Institute, Toronto, ON, Canada
| | - Catherine S. Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Kelley
- Department of Psychiatry, Queens University, Kingston, ON, Canada
- Department of Psychology, Faculty of Arts and Science, Queens University, Kingston, ON, Canada
| | - Christie L. Burton
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Nicolson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Daphne J. Korczak
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19
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Newton AS, Prisnie K, Macdonald LA, Eltorki M, Finkelstein Y, Fitzpatrick E, Gagnon I, Greenfield B, Joubert GI, Katz LY, Lipman EL, Mater A, Plotnick LH, Porter R, Sawyer S, St John KA, Sukhera J, Szatmari P, Rasiah J, Steele M, Hall P, Thull-Freedman J, Taljaard M, Cappelli M, Clark SE, Cost KT, Round J, Cherry J, Monga S, Sareen J, Klassen TP, Freedman SB. An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:946-948. [PMID: 35772868 DOI: 10.1016/j.jaac.2022.04.001] [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: 10/18/2021] [Revised: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.
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Affiliation(s)
| | - Kassi Prisnie
- Cumming School of Medicine, University of Calgary, Alberta
| | - Lee A Macdonald
- Planning and Performance, Alberta Health Services, Edmonton, Alberta
| | | | | | | | - Isabelle Gagnon
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec
| | - Brian Greenfield
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Gary I Joubert
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | | | | | - Ahmed Mater
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Laurie H Plotnick
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Robert Porter
- Memorial University of Newfoundland, St. John's, Newfoundland
| | - Scott Sawyer
- Rady Faculty of Health Sciences, Winnipeg, Manitoba
| | | | - Javeed Sukhera
- Institute of Living and Hartford Hospital, Hartford, Connecticut
| | - Peter Szatmari
- Hospital for Sick Children, University of Toronto, Ontario; The Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Margaret Steele
- Memorial University of Newfoundland, St. John's, Newfoundland
| | - Patricia Hall
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
| | - Mario Cappelli
- Ontario Centre of Excellence for Child & Youth Mental Health, Ottawa, Ontario
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia
| | - Katherine T Cost
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta
| | | | - Suneeta Monga
- Hospital for Sick Children, University of Toronto, Ontario
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20
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Rasiah J, Freedman S, Macdonald L, Prisnie K, Eltorki M, Finkelstein Y, Hopkin G, Santana MJ, Thull-Freedman J, Stang A, Prebeg M, Gagnon IJ, Steele M, Mater A, Katz L, Greenfield B, Plotnick L, Monga S, Lipman EL, Wright B, Dimitropoulos G, Porter R, Hurley K, Al Hamarneh YN, Newton A. Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study. BMJ Open 2022; 12:e059689. [PMID: 35715176 PMCID: PMC9207895 DOI: 10.1136/bmjopen-2021-059689] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER NCT04902391.
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Affiliation(s)
- Jananee Rasiah
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen Freedman
- Departments of Pediatrics, Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, The Hospital for Sick Children, Calgary, Alberta, Canada
| | - Lee Macdonald
- Planning and Performance, Alberta Health Services, Calgary, Alberta, Canada
| | - Kassi Prisnie
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mohamed Eltorki
- Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Yaron Finkelstein
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Gareth Hopkin
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Trauma Department, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ahmed Mater
- Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laurence Katz
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ellen Louise Lipman
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bruce Wright
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Robert Porter
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Katrina Hurley
- Emergency Medicine Deparment, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Amanda Newton
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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21
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Mental health profiles of autistic children and youth during the COVID-19 pandemic. Paediatr Child Health 2022; 27:S59-S65. [PMID: 35615409 PMCID: PMC9126276 DOI: 10.1093/pch/pxab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Canadian province-wide lockdowns have challenged children's mental health (MH) during the COVID-19 pandemic, with autistic children being at particular risk. The purpose of our study was to identify sub-groups of autistic children with distinct mental health change profiles, to understand the child-, parent-, and system-specific factors associated with such profiles in order to ultimately inform future interventions. Methods Data were drawn from a large Canadian cohort (N=1,570) across Ontario, resulting in 265 autistic children (mean age=10.9 years, 76% male). K-means clustering analyses were employed to partition distinct MH profiles in six MH measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and group differences were examined with reference to the above factors. Additionally, we investigated the characteristics of children who accessed acute MH services. Results The optimal number of clusters was two; one included those experiencing MH deterioration across all six MH measures (61.3%, 95% confidence interval [CI]=54.9 to 67.4), and a second included youth that did not experience MH changes (38.7%, 95%CI=32.6 to 45.1). Child-specific factors associated with MH deterioration included higher pre-existing internalizing symptoms, high levels of COVID stress. Parental MH challenges and system-specific factors, such as the loss of learning supports, access to physicians and material deprivation, were also associated with MH deterioration. Access to acute MH services were primarily associated with financial insecurity and loss of services. Conclusions More than half of autistic children experienced MH deterioration, and person-specific (pre-existing MH, COVID related stress), parent-specific (Parent MH) and system-level (loss of services and material deprivation) characteristics were associated with such decline, providing clinical and policy opportunities for intervention at multiple levels.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine T Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada.,Institute for Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Romanchych E, Desai R, Bartha C, Carson N, Korenblum M, Monga S. Healthcare providers' perceptions of virtual-care with children's mental health in a pandemic: A hospital and community perspective. Early Interv Psychiatry 2022; 16:433-443. [PMID: 34309196 PMCID: PMC8444835 DOI: 10.1111/eip.13196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/21/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022]
Abstract
AIM The purpose of the present study was to explore the experiences of a diverse group of mental health clinicians both in hospital and in the community, who were required to rapidly adopt virtual-care practices in the delivery of mental health services to children, adolescents, and their families. METHODS Mental health clinicians (N = 117) completed the Clinician Virtual-Care Experience Survey assessing the following domains: ease of technology use, client/patient-provider interaction quality, and clinician wellbeing. RESULTS Although over 70% of clinicians had not used virtual-care to deliver mental health services prior to the Coronavirus Disease 2019 pandemic, more than 80% felt it was easy to operate the virtual platforms. Clinicians were divided in their perceptions of the effectiveness of virtual-care, with only 42% reporting that they felt they were as effective in delivering healthcare services virtually as compared to in-person. Virtual-care was described as being more effective for specific populations, while challenges were described in building rapport and when delivering difficult or unexpected feedback. CONCLUSIONS Clinicians felt there were some benefits of adopting virtual-care practices, while challenges were also identified. Understanding of the impact of virtual-care on service providers is essential in order to strengthen mental healthcare for children, adolescents, and their families even beyond the pandemic.
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Affiliation(s)
- Erin Romanchych
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Riddhi Desai
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Christina Bartha
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada.,SickKids Centre for Community Mental Health, Toronto, Canada
| | - Neill Carson
- SickKids Centre for Community Mental Health, Toronto, Canada
| | - Marshall Korenblum
- SickKids Centre for Community Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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23
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Korczak DJ, Cost KT, LaForge-MacKenzie K, Anagnostou E, Birken CS, Charach A, Monga S, Crosbie J. Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic. BMJ Open 2022; 12:e057248. [PMID: 35236733 PMCID: PMC8895414 DOI: 10.1136/bmjopen-2021-057248] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic. METHODS AND ANALYSIS Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods. ETHICS AND DISSEMINATION The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.
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Affiliation(s)
- Daphne J Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Katherine T Cost
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Evdokia Anagnostou
- Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alice Charach
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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24
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Li X, Vanderloo LM, Keown-Stoneman CDG, Cost KT, Charach A, Maguire JL, Monga S, Crosbie J, Burton C, Anagnostou E, Georgiades S, Nicolson R, Kelley E, Ayub M, Korczak DJ, Birken CS. Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2140875. [PMID: 34962557 PMCID: PMC8715351 DOI: 10.1001/jamanetworkopen.2021.40875] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Longitudinal research on specific forms of electronic screen use and mental health symptoms in children and youth during COVID-19 is minimal. Understanding the association may help develop policies and interventions targeting specific screen activities to promote healthful screen use and mental health in children and youth. OBJECTIVE To determine whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study with repeated measures of exposures and outcomes was conducted in children and youth aged 2 to 18 years in Ontario, Canada, between May 2020 and April 2021 across 4 cohorts of children or youth: 2 community cohorts and 2 clinically referred cohorts. Parents were asked to complete repeated questionnaires about their children's health behaviors and mental health symptoms during COVID-19. MAIN OUTCOMES AND MEASURES The exposure variables were children's daily TV or digital media time, video game time, electronic-learning time, and video-chatting time. The mental health outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention using validated standardized tools. RESULTS This study included 2026 children with 6648 observations. In younger children (mean [SD] age, 5.9 [2.5] years; 275 male participants [51.7%]), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: β, 0.22 [95% CI, 0.10-0.35]; P < .001; age ≥4 years: β, 0.07 [95% CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (β, 0.07 [95% CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 male participants [56.5%]), higher levels of TV or digital media time were associated with higher levels of depression, anxiety, and inattention; higher levels of video game time were associated with higher levels of depression, irritability, inattention, and hyperactivity. Higher levels of electronic learning time were associated with higher levels of depression and anxiety. CONCLUSIONS AND RELEVANCE In this cohort study, higher levels of screen use were associated poor mental health of children and youth during the COVID-19 pandemic. These findings suggest that policy intervention as well as evidence-informed social supports are needed to promote healthful screen use and mental health in children and youth during the pandemic and beyond.
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Affiliation(s)
- Xuedi Li
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leigh M. Vanderloo
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- School of Occupational Therapy, Western University, London, Ontario, Canada
- ParticipACTION, Toronto, Ontario, Canada
| | - Charles D. G. Keown-Stoneman
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Alice Charach
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christie Burton
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queens University, Kingston, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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25
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Rizeq J, Korczak DJ, Cost KT, Anagnostou E, Charach A, Monga S, Birken CS, Kelley E, Nicolson R, Burton CL, Crosbie J. Vulnerability pathways to mental health outcomes in children and parents during COVID-19. Curr Psychol 2021; 42:1-11. [PMID: 34815638 PMCID: PMC8603653 DOI: 10.1007/s12144-021-02459-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 10/27/2022]
Abstract
We examined pathways from pre-existing psychosocial and economic vulnerability to mental health difficulties and stress in families during the COVID-19 pandemic. Data from two time points from a multi-cohort study initiated during the COVID-19 pandemic were used. Parents of children 6-18 years completed questionnaires on pre-COVID-19 socioeconomic and demographic factors in addition to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning. Youth 10 years and older also completed their own measures of mental health and stress. Using structural equation modelling, pathways from pre-existing vulnerability to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning, including reciprocal pathways, were estimated. Pre-existing psychosocial and economic vulnerability predicted higher material deprivation due to COVID-19 restrictions which in turn was associated with parent and child stress due to restrictions and mental health difficulties. The reciprocal effects between increased child and parent stress and greater mental health difficulties at Time 1 and 2 were significant. Reciprocal effects between parent and child mental health were also significant. Finally, family functioning at Time 2 was negatively impacted by child and parent mental health and stress due to COVID-19 restrictions at Time 1. Psychosocial and economic vulnerability is a risk factor for material deprivation during COVID-19, increasing the risk of mental health difficulties and stress, and their reciprocal effects over time within families. Implications for prevention policy and parent and child mental health services are discussed. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12144-021-02459-z.
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Affiliation(s)
- Jala Rizeq
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Katherine Tombeau Cost
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
| | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Holland Bloorview Research Institute, Toronto, ON Canada
| | - Alice Charach
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Catherine S. Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON Canada
| | - Elizabeth Kelley
- Department of Psychology, Queens University, Kingston, ON Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, ON Canada
| | - Spit for Science
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Holland Bloorview Research Institute, Toronto, ON Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychology, Queens University, Kingston, ON Canada
- Department of Psychiatry, Western University, London, ON Canada
| | - Christie L. Burton
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children (SickKids), 555 University Ave, Psychiatry Research, 4th Floor, Black Wing, Toronto, ON M5G 1X8 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
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26
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Courtney DB, Watson P, Chan BW, Bennett K, Krause KR, Offringa M, Butcher NJ, Monga S, Neprily K, Zentner T, Rodak T, Szatmari P. Forks in the road: Definitions of response, remission, recovery, and other dichotomized outcomes in randomized controlled trials for adolescent depression. A scoping review. Depress Anxiety 2021; 38:1152-1168. [PMID: 34312952 DOI: 10.1002/da.23200] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Definitions of dichotomous outcome terms, such as "response," "remission," and "recovery" are central to the design, interpretation, and clinical application of randomized controlled trials of adolescent depression interventions. Accordingly, this scoping review was conducted to document how these terms have been defined and justified in clinical trials. METHOD Bibliographic databases MEDLINE, Embase, APA PsycInfo, and CINAHL were searched from inception to February 2020 for randomized controlled trials evaluating treatments for adolescent depression. Ninety-eight trials were included for data extraction and analysis. RESULTS Assessment of outcome measurement instruments, metric strategies, methods of aggregation, and measurement timing, yielded 53 unique outcome definitions of "response" across 45 trials that assessed response, 47 unique definitions of "remission" in 29 trials that assessed remission, and 19 unique definitions of "recovery" across 11 trials that assessed recovery. A minority of trials (N = 35) provided a rationale for dichotomous outcomes definitions, often by citing other studies that used a similar definition (N = 11). No rationale included input from youth or families with lived experience. CONCLUSION Our review revealed that definitions of "response," "remission," "recovery," and related terms are highly variable, lack clear rationales, and are not informed by key stakeholder input. These limitations impair pooling of trial results and the incorporation of trial findings into pragmatic treatment decisions in clinical practice. Systematic approaches to establishing outcome definitions are needed to enhance the impact of trials examining adolescent depression treatment.
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Affiliation(s)
- Darren B Courtney
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Priya Watson
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | | | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster Univeristy, Toronto, Ontario
| | | | - Martin Offringa
- Department of Pediatrics, Neonatology, University of Toronto, Toronto, Ontario
| | - Nancy J Butcher
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Suneeta Monga
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Kirsten Neprily
- Department of Psychology, School and Applied Child Psychology, University of Calgary, Calgary, Alberta
| | - Tabitha Zentner
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Peter Szatmari
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
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Hawke LD, Monga S, Korczak D, Hayes E, Relihan J, Darnay K, Cleverley K, Lunsky Y, Szatmari P, Henderson J. Impacts of the COVID-19 pandemic on youth mental health among youth with physical health challenges. Early Interv Psychiatry 2021; 15:1146-1153. [PMID: 33047495 PMCID: PMC7675347 DOI: 10.1111/eip.13052] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 09/26/2020] [Indexed: 12/28/2022]
Abstract
AIM To examine mental health in conjunction with physical health during the COVID-19 pandemic among youth with physical health conditions compared to those without. METHODS A cross-sectional survey of 622 youth aged 14 to 28 was conducted. Analyses were conducted to understand the changes in mental and physical health among youth in four groups: (a) participants with a friend or family member diagnosed with COVID-19, (b) participants with symptoms associated with COVID-19, (c) participants with atopic conditions (asthma and allergies), and (d) participants with other preexisting physical health conditions. RESULTS Many participants with physical health concerns met screening criteria for an internalizing disorder, which was significantly higher than the rate found among participants without physical health conditions. Significantly greater declines in self-reported mental health were observed during the COVID-19 period compared to 3 months earlier among youth reporting physical health concerns compared to those without physical health concerns. Substance use does not appear to have been affected. CONCLUSIONS Mental health concerns are highly prevalent among youth with physical health concerns, and also appear to be exacerbated by the COVID-19 pandemic. Physical health concerns appear to constitute risk factors for heightened mental health responses to the pandemic situation. System planners striving to adapt mental health services to meet social/physical distancing recommendations are urged to consider youth with physical health conditions and ensure that adequate integrated mental health and physical health supports are available to them.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Suneeta Monga
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Daphne Korczak
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Em Hayes
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | | | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
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Cardy RE, Dupuis A, Anagnostou E, Ziolkowski J, Biddiss EA, Monga S, Brian J, Penner M, Kushki A. Characterizing Changes in Screen Time During the COVID-19 Pandemic School Closures in Canada and Its Perceived Impact on Children With Autism Spectrum Disorder. Front Psychiatry 2021; 12:702774. [PMID: 34483995 PMCID: PMC8416261 DOI: 10.3389/fpsyt.2021.702774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has led to an increase in screen time for children and families. Traditionally, screen time has been associated with negative physical and mental health outcomes, and children with autism spectrum disorder (ASD) are at increased risk of these outcomes. The primary objectives of this study were to (1) characterize the change in screen time during COVID-19 school closures for children with ASD, and (2) examine the parent perceived impact of screen time on mental health and quality of life of children and their families. Canadian parents and caregivers of children 19 years of age and younger were eligible to participate in an anonymous, online survey study. This survey was available in English, consisted of 28 questions, took ~10-min to complete, and was available for 6 weeks (May 22 through July 6, 2020). The total sample consisted of 414 responses (ASD: n = 127, mean age = 11.7 ± 4.06 years; community sample: n = 287, mean age = 9.4 ± 4.26 years). Seventy-one respondents were missing responses to our primary question and removed from the analyses (final sample n = 344). Compared to the community sample, the ASD group had a significantly higher screen time use before and during the COVID-19 pandemic school closures [weekdays: difference = 1.14 (SE = 0.18), t = 6.56, p < 0.0001; weekends: difference = 1.41 (SE = 0.20), t = 6.93, p < 0.0001]. Mean total screen time during the pandemic was 6.9 h (95% CI 6.49, 7.21) on weekdays and 6.3 h (95% CI 5.91, 6.63) on weekends for the ASD group, and 5.6 h (95% CI 5.28, 5.92) on weekdays and 5.0 h (95% CI 4.70, 5.34) on weekends for the community sample. There was a significant increase in screen time during the COVID-19 pandemic as compared to before the pandemic period in the ASD group [weekdays: mean difference = 3.8 h (95% CI 3.35-4.25), p < 0.0001; weekends: mean difference = 1.5 h (95% CI 1.17-1.92), p < 0.0001]. Gender was a significant predictor of parent perceived mental health and quality of life, with male gender associated with a higher likelihood of negative impact [quality of life (child/family) OR = 1.8 (95% CI 1.1-2.9), corrected p = 0.040; mental health OR = 1.9 (95% CI 1.1-3.1), corrected p = 0.0028]. Parents' most frequently endorsed emotions toward screen time were guilt, frustration, and worry. Results of this survey study revealed that children with ASD were less likely to benefit from screen time to cope with social isolation, and screen time resulted in significantly more lost time on social interactions than the community sample, which may exacerbate difficulties in social domains. Given the unprecedented circumstances of the COVID-19 pandemic and the novel context of technology use, the findings of this study highlight the need for revision of screen time recommendations to reflect the current needs of children and families.
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Affiliation(s)
- Robyn E Cardy
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Annie Dupuis
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Justine Ziolkowski
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Elaine A Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Jessica Brian
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Melanie Penner
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Azadeh Kushki
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Cleverley K, Stevens K, Davies J, McCann E, Ashley T, Brathwaite D, Gebreyohannes M, Nasir S, O'Reilly K, Bennett KJ, Brennenstuhl S, Charach A, Henderson J, Jeffs L, Korczak DJ, Monga S, de Oliveira C, Szatmari P. Mixed-methods study protocol for an evaluation of the mental health transition navigator model in child and adolescent mental health services: the Navigator Evaluation Advancing Transitions (NEAT) study. BMJ Open 2021; 11:e051190. [PMID: 34187834 PMCID: PMC8245465 DOI: 10.1136/bmjopen-2021-051190] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Transition from child and adolescent mental health services (CAMHS) to community or adult mental health services (AMHS) is a highly problematic health systems hurdle, especially for transition-aged youth. A planned and purposeful transition process is often non-existent or experienced negatively by youth and their caregivers. Stakeholders, including youth and their caregivers, have demanded interventions to support more effective transitions, such a transition navigator. The transition navigator model uses a navigator to facilitate complex transitions from acute care CAMHS to community or AMHS. However, despite the widespread implementation of this model, there has been no evaluation of the programme, hindering its scalability. This paper describes the study protocol of the Navigator Evaluation Advancing Transitions study that aims to collaborate with patients, caregivers and clinicians in the evaluation of the navigator model. METHODS AND ANALYSIS A pre and post mixed-method study will be conducted, using the Triple Aim Framework, to evaluate the navigator model. We will recruit participants from one large tertiary and two community hospitals in Toronto, Canada. For the quantitative portion of the study, we will recruit a sample of 45 youth (15 at each site), aged 16-18, and their caregivers at baseline (referral to navigator) (T1) and 6 months (T2). Youth and caregiver participants will complete a set of standardised measures to assess mental health, service utilisation, and satisfaction outcomes. For the qualitative portion of the study, semistructured interviews will be conducted at 6 months (T2) with youth, their caregivers and clinicians to better understand their experience and satisfaction with the model. ETHICS AND DISSEMINATION Research Ethics Board (REB) approval has been obtained from the lead research sites, the University of Toronto and the Hospital for Sick Children. The results of the study will be reported in peer-reviewed publications, webinars and conferences and to all relevant stakeholders.
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Affiliation(s)
- Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katye Stevens
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Julia Davies
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Emma McCann
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Ashley
- Lumenus Community Services, Toronto, Ontario, Canada
| | - Daneisha Brathwaite
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mana Gebreyohannes
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Saba Nasir
- Lumenus Community Services, Toronto, Ontario, Canada
| | - Katelyn O'Reilly
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn J Bennett
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alice Charach
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suneeta Monga
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Ansari H, Santiago-Jiménez M, Saab H, De Souza C, Szatmari P, Monga S. Association Between Comorbid Psychiatric Disorders and Hospital Resource Use in Physically Ill Pediatric Inpatients: A Case-Matched Analysis. J Am Acad Child Adolesc Psychiatry 2021; 60:346-354. [PMID: 32738281 DOI: 10.1016/j.jaac.2020.07.889] [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] [Received: 12/02/2019] [Revised: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To understand differences in hospital length of stay and costs associated with the presence of a comorbid psychiatric disorder among physically ill inpatients within a publicly funded pediatric hospital. METHOD This was a retrospective observational design using administrative data on physically ill inpatients 2 to 18 years old who were admitted over a 5-year period (n = 54,316 admissions). Records with (n = 4,953) and without (n = 49,363) documented comorbid psychiatric disorder were compared for differences in baseline characteristics. To optimize the balance of measured covariates, individuals with comorbid psychiatric disorders were matched on propensity score, case mix group, and Elixhauser comorbidities, resulting in 4,371 pairs of inpatients with and without a comorbid psychiatric disorder. Differences in length of stay and total hospital costs were assessed using generalized estimating equation models on matched patients. RESULTS Unmatched analyses demonstrated that inpatient admissions with comorbid psychiatric disorders were associated with higher occurrence of previous hospitalizations (69.2% versus 55.0%), unscheduled admissions (66.9% versus 60.9%), medical admissions (75.6% versus 52.7%), urgent admissions (62.5% versus 56.2%), and Elixhauser comorbidities (69.0% versus 39.0%), with standardized differences > |0.1|. Matched analyses demonstrated a 9.6% longer length of stay (95% CI = 5.7-13.7; p < .001) and 9.6% higher costs per admission (95% CI = 5.9-13.4; p < .001) in inpatients with comorbid psychiatric disorders compared to those without. CONCLUSION The complexity of inpatients with a comorbid psychiatric disorder, in conjunction with the approximate 10% increase in hospital resource use, highlights the need for innovative models of clinical care and research directed at improving patient outcomes and reducing hospital costs.
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Affiliation(s)
- Hina Ansari
- The Hospital for Sick Children, Toronto, Canada; Institute of Health Policy, Management and Evaluation at the University of Toronto, Canada
| | | | - Hana Saab
- The Hospital for Sick Children, Toronto, Canada
| | - Claire De Souza
- The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Canada
| | - Peter Szatmari
- The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Suneeta Monga
- The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Canada.
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Stallwood E, Monsour A, Rodrigues C, Monga S, Terwee C, Offringa M, Butcher NJ. Systematic Review: The Measurement Properties of the Children's Depression Rating Scale-Revised in Adolescents With Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:119-133. [PMID: 33130251 DOI: 10.1016/j.jaac.2020.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/23/2019] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To systematically appraise existing evidence of the measurement properties of the Children's Depression Rating Scale-Revised (CDRS-R) in adolescents with major depressive disorder (MDD). The CDRS-R is the most commonly used scale in adolescent depression research, yet was originally designed for use in children 6 to 12 years old. METHOD Seven databases were searched for studies that evaluated the measurement properties of the CDRS-R in adolescents (ages 12-18 years). Of 65 studies screened by full-text, 6 were included. Measurement properties were appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. The COSMIN minimum requirements for recommending the use of an outcome measurement instrument are (1) evidence for sufficient content validity (any level of evidence), and (2) at least low-quality evidence for sufficient internal consistency. RESULTS Four studies assessed an English-language version of the CDRS-R; the other 2 assessed German and Korean versions, respectively. No study assessed content validity, cross-cultural validity/measurement invariance, or measurement error of the CDRS-R in adolescents with MDD. Low-quality evidence was found for sufficient construct validity (n = 4 studies) and responsiveness (n = 2 studies) assessed via comparator instruments. Very-low-quality evidence was found for sufficient interrater reliability (n = 2 studies). The results for structural validity (n = 3 studies) and internal consistency (n = 5 studies) were inconclusive. CONCLUSION It remains unclear whether the CDRS-R appropriately measures depressive symptom severity in adolescent MDD. Before use of the CDRS-R in adolescent MDD research can be recommended, evidence of sufficient psychometric properties in adolescents with MDD is needed.
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Affiliation(s)
- Emma Stallwood
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Andrea Monsour
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Craig Rodrigues
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Suneeta Monga
- Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Caroline Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Martin Offringa
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Nancy J Butcher
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada.
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Doan BT, Yang YB, Romanchych E, Grewal S, Monga S, Pignatiello T, Bryden P, Kulkarni C. From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19. J Contemp Psychother 2020; 51:1-7. [PMID: 33110276 PMCID: PMC7582436 DOI: 10.1007/s10879-020-09478-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients’ homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services.
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Affiliation(s)
- Bridget T Doan
- Hospital for Sick Children (SickKids), Toronto, ON Canada
| | - Yue Bo Yang
- MD Undergraduate Program, University of British Columbia, Vancouver, BC Canada
| | | | - Seena Grewal
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Suneeta Monga
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Tony Pignatiello
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Pier Bryden
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
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Mew EJ, Monsour A, Saeed L, Santos L, Patel S, Courtney DB, Watson PN, Szatmari P, Offringa M, Monga S, Butcher NJ. Systematic scoping review identifies heterogeneity in outcomes measured in adolescent depression clinical trials. J Clin Epidemiol 2020; 126:71-79. [DOI: 10.1016/j.jclinepi.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
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Tracey M, Finkelstein Y, Schachter R, Cleverley K, Monga S, Barwick M, Szatmari P, Moretti ME, Willan A, Henderson J, Korczak DJ. Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention. BMC Med Res Methodol 2020; 20:231. [PMID: 32928140 PMCID: PMC7490899 DOI: 10.1186/s12874-020-01117-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors. METHODS Recruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity. RESULTS In response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials. CONCLUSIONS EDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment. TRIAL REGISTRATION ClinicalTrials.gov : NCT03488602 , retrospectively registered April 4, 2018.
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Affiliation(s)
- Matthew Tracey
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Yaron Finkelstein
- Divisions of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, 525 University Avenue, Toronto, ON, M5G 2L3, Canada
| | - Reva Schachter
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, 130-155 College Street, Toronto, ON, M5P 1T8, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada
| | - Melanie Barwick
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada.,Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada
| | - Myla E Moretti
- Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Andrew Willan
- Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 5226-88 Workman Way, Toronto, ON, M5J 1H4, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Monsour A, Mew EJ, Patel S, Chee-A-Tow A, Saeed L, Santos L, Courtney DB, Watson PN, Monga S, Szatmari P, Offringa M, Butcher NJ. Primary outcome reporting in adolescent depression clinical trials needs standardization. BMC Med Res Methodol 2020; 20:129. [PMID: 32450810 PMCID: PMC7247139 DOI: 10.1186/s12874-020-01019-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 01/13/2020] [Accepted: 05/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence-based health care is informed by results of randomized clinical trials (RCTs) and their syntheses in meta-analyses. When the trial outcomes measured are not clearly described in trial publications, knowledge synthesis, translation, and decision-making may be impeded. While heterogeneity in outcomes measured in adolescent major depressive disorder (MDD) RCTs has been described, the comprehensiveness of outcome reporting is unknown. This study aimed to assess the reporting of primary outcomes in RCTs evaluating treatments for adolescent MDD. METHODS RCTs evaluating treatment interventions in adolescents with a diagnosis of MDD published between 2008 and 2017 specifying a single primary outcome were eligible for outcome reporting assessment. Outcome reporting assessment was done independently in duplicate using a comprehensive checklist of 58 reporting items. Primary outcome information provided in each RCT publication was scored as "fully reported", "partially reported", or "not reported" for each checklist item, as applicable. RESULTS Eighteen of 42 identified articles were found to have a discernable single primary outcome and were included for outcome reporting assessment. Most trials (72%) did not fully report on over half of the 58 checklist items. Items describing masking of outcome assessors, timing and frequency of outcome assessment, and outcome analyses were fully reported in over 70% of trials. Items less frequently reported included outcome measurement instrument properties (ranging from 6 to 17%), justification of timing and frequency of outcome assessment (6%), and justification of criteria used for clinically significant differences (17%). The overall comprehensiveness of reporting appeared stable over time. CONCLUSIONS Heterogeneous reporting exists in published adolescent MDD RCTs, with frequent omissions of key details about their primary outcomes. These omissions may impair interpretability, replicability, and synthesis of RCTs that inform clinical guidelines and decision-making in this field. Consensus on the minimal criteria for outcome reporting in adolescent MDD RCTs is needed.
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Affiliation(s)
- Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Sagar Patel
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Lucia Santos
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya N Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
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Kamani Z, Monga S. Understanding the Outcome of Children who Selectively Do not Speak: A Retrospective Approach. J Can Acad Child Adolesc Psychiatry 2020; 29:58-65. [PMID: 32405308 PMCID: PMC7213919] [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] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Little is known about the longer-term outcomes of children diagnosed with selective mutism (SM) and/or social anxiety disorder (SAD); two anxiety disorders characterized by difficulties speaking in social situations despite being able to speak in other contexts. OBJECTIVE This retrospective study aimed to descriptively evaluate the long-term SM and SAD diagnostic and symptom severity outcomes in a clinical youth sample. METHODS Retrospective follow-up interviews were conducted with 31 parents of children/youth aged four to 14 years previously referred to a specialized anxiety clinic and diagnosed with SM and/or SAD (mean follow-up 4.2 years). Clinician and parent-report measures were used to determine follow-up diagnosis and symptom severity. RESULTS The majority (71%; n=22) of participants still met criteria for SM and/or SAD. Of these, 11 had SAD only; nine had a comorbid diagnosis of SM and SAD; and two had SM only. At follow-up 42% (n=13) were receiving school supports. Close to half (48%; n=15) of parents continued to express concerns about their child's anxiety. Almost all (90%, n=28) youth had attempted some form of treatment, with group cognitive behavioural therapy (CBT) reported as the most common form of treatment tried (48%, n=15). Almost thirty percent (29%, n=9) reported taking anxiety medications in the past with several (13%, n=4) still on medications at follow-up. CONCLUSION Study results suggest that symptoms of SM and SAD persist in the longer-term. Further investigation into the differences between diagnostic groups and their long-term treatment outcomes is clearly warranted.
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Affiliation(s)
- Zehra Kamani
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Monga S, Offringa M, Butcher NJ, Szatmari P. From Research to Practice: The Importance of Appropriate Outcome Selection, Measurement, and Reporting in Pediatric Mental Health Research. J Am Acad Child Adolesc Psychiatry 2020; 59:497-500. [PMID: 32220402 DOI: 10.1016/j.jaac.2019.08.468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 11/18/2022]
Abstract
Results of randomized controlled trials (RCTs) and, ideally, the synthesis of RCT results into meta-analyses, drive both clinical and policy decision making about health care interventions and inform new avenues for research. Selection of the right health outcomes to measure, analyze, and report on when designing a trial therefore is key in ensuring that the research will be useful and will have maximum impact.1-3 As in many areas of medicine, wide variability exists in pediatric mental health research as to which outcomes are selected, how they are measured, and how they are reported. Variability in outcome selection and measurement may stem from various factors, including a tendency to select what is feasible or historical to measure rather than a focus on what is important to measure and how best to measure it. The resulting variability limits comparing and combining the results from different trials addressing a similar question in meta-analyses, hindering the translation of research to practice.1,2 The objective of this article is to highlight the importance of outcome selection, measurement, and reporting in the translation of research to clinical practice.
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Affiliation(s)
- Suneeta Monga
- Cundill Centre for Children and Youth Depression, Centre for Addiction and Mental Health, Ontario, Canada; The Hospital for Sick Children, and the University of Toronto, Ontario, Canada.
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Children and Youth Depression, Centre for Addiction and Mental Health, Ontario, Canada; The Hospital for Sick Children, and the University of Toronto, Ontario, Canada
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Korczak DJ, Finkelstein Y, Barwick M, Chaim G, Cleverley K, Henderson J, Monga S, Moretti ME, Willan A, Szatmari P. A suicide prevention strategy for youth presenting to the emergency department with suicide related behaviour: protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:20. [PMID: 31937274 PMCID: PMC6961291 DOI: 10.1186/s12888-019-2422-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/09/2018] [Accepted: 12/26/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death among adolescents in North America. Youth who present to the Emergency Department (ED) with acute suicidality are at increased risk for eventual death by suicide, thereby presenting an opportunity for secondary prevention of suicide. The current study evaluates the effectiveness of a standardized individual and family-based suicidal behaviour risk reduction intervention targeting adolescents at high-risk for suicide. METHODS A randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of a manualized youth- and family- based suicide prevention strategy (SPS) as compared with case navigation (NAV) among adolescents aged 12 to 18 years of age who present to the ED with acute suicidal ideation (SI) or suicide risk behaviours (SRB). We will recruit 128 participants and compare psychiatric symptoms including SI/SRB, family communication, and functional impairment at baseline and follow-ups (post-intervention [6 weeks], 24 weeks). The primary outcome is change in suicidal ideation measured with the Suicide Ideation Questionnaire- Junior. SRBs are measured with the Suicide Behaviour Questionnaire. Secondary outcomes are change in depressive and anxious symptoms measured with semi-structured psychiatric interview and Screen for Child Anxiety Related Disorders; acute mental health crises measured by urgent medical (including ED) visits; family communication measured with Conflict Behaviour Questionnaire, functional impairment measured by Columbia Impairment Scale; cost effectiveness, and fidelity of implementation measured by audio recording and fidelity checklist. DISCUSSION Results of this study will inform a larger multi-centre RCT that will include both community and academic hospitals in urban and rural settings. Study results will be shared at international psychiatry and emergency medicine meetings, in local rounds, and via publication in academic journals and clinician-oriented newsletters. If effective, the intervention may provide a brief, scalable, and transportable treatment program that may be implemented in a variety of settings, including those in which access to children's mental health care services is challenging. TRIAL REGISTRATION ClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.
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Affiliation(s)
- Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, , Toronto, ON, Canada. .,Research Institute, Hospital for Sick Children, Toronto, ON, Canada. .,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Yaron Finkelstein
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Division of Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Melanie Barwick
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gloria Chaim
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kristin Cleverley
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Joanna Henderson
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, , Toronto, ON, Canada.,Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Myla E Moretti
- Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrew Willan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, , Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Szatmari P, Offringa M, Butcher NJ, Monga S. Counting What Counts: The Case for Harmonized Outcomes in Child and Youth Mental Health Research. J Am Acad Child Adolesc Psychiatry 2019; 58:656-658. [PMID: 31229181 DOI: 10.1016/j.jaac.2019.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/06/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 01/11/2023]
Abstract
Evidence-based mental health care for children and youth critically depends on properly conducted randomized controlled trials (RCTs) and prospective studies that investigate change in mental health outcomes over time. As evidence accumulates, it can be synthesized through systematic reviews and meta-analyses that combine the results of many studies into a single estimate of effect. Clinical practice guidelines incorporate this information along with input from stakeholders and content experts, who fill in evidence gaps to formulate recommendations for best practice. Collectively, this evidence generation and synthesis process, once implemented, supports better long-term outcomes for the population by highlighting the "best available evidence" and reducing variability in clinical care. In addition, this process identifies knowledge gaps that might inform the field's research agenda. The objective of this commentary is to examine the potential of developing and implementing "Core Outcome Sets" (COS) as a means of reducing variability in the measurement and reporting of outcomes across RCTs and cohort studies, and thereby promoting the translation of evidence to practice.
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Affiliation(s)
- Peter Szatmari
- The Hospital for Sick Children and the University of Toronto, Ontario, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Suneeta Monga
- The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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Campisi SC, Wasan Y, Soofi S, Monga S, Korczak DJ, Lou W, Soder O, Vandermorris A, Humayun KN, Mian A, Szatmari P, Bhutta ZA. Nash-wo-Numa (childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan. BMJ Open 2019; 9:e028343. [PMID: 31196903 PMCID: PMC6575710 DOI: 10.1136/bmjopen-2018-028343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/19/2022] Open
Abstract
INTRODUCTION Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world's largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study's primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition. METHODS This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales. ETHICS AND DISSEMINATION The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03647553; Pre-results.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yaqub Wasan
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Suneeta Monga
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Olle Soder
- Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ayesha Mian
- Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Peter Szatmari
- Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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Butcher NJ, Monsour A, Mew EJ, Szatmari P, Pierro A, Kelly LE, Farid-Kapadia M, Chee-A-Tow A, Saeed L, Monga S, Ungar W, Terwee CB, Vohra S, Fergusson D, Askie LM, Williamson PR, Chan AW, Moher D, Offringa M. Improving outcome reporting in clinical trial reports and protocols: study protocol for the Instrument for reporting Planned Endpoints in Clinical Trials (InsPECT). Trials 2019; 20:161. [PMID: 30841935 PMCID: PMC6404348 DOI: 10.1186/s13063-019-3248-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Inadequate and poor quality outcome reporting in clinical trials is a well-documented problem that impedes the ability of researchers to evaluate, replicate, synthesize, and build upon study findings and impacts evidence-based decision-making by patients, clinicians, and policy-makers. To facilitate harmonized and transparent reporting of outcomes in trial protocols and published reports, the Instrument for reporting Planned Endpoints in Clinical Trials (InsPECT) is being developed. The final product will provide unique InsPECT extensions to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) reporting guidelines. Methods The InsPECT SPIRIT and CONSORT extensions will be developed in accordance with the methodological framework created by the EQUATOR (Enhancing the Quality and Transparency of Health Research Quality) Network for reporting guideline development. Development will consist of (1) the creation of an initial list of candidate outcome reporting items synthesized from expert consultations and a scoping review of existing guidance for reporting outcomes in trial protocols and reports; (2) a three-round international Delphi study to identify additional candidate items and assess candidate item importance on a 9-point Likert scale, completed by stakeholders such as trial report and protocol authors, systematic review authors, biostatisticians and epidemiologists, reporting guideline developers, clinicians, journal editors, and research ethics board representatives; and (3) an in-person expert consensus meeting to finalize the set of essential outcome reporting items for trial protocols and reports, respectively. The consensus meeting discussions will be independently facilitated and informed by the empirical evidence identified in the primary literature and through the opinions (aggregate rankings and comments) collected via the Delphi study. An integrated knowledge translation approach will be used throughout InsPECT development to facilitate implementation and dissemination, in addition to standard post-development activities. Discussion InsPECT will provide evidence-informed and consensus-based standards focused on outcome reporting in clinical trials that can be applied across diverse disease areas, study populations, and outcomes. InsPECT will support the standardization of trial outcome reporting, which will maximize trial usability, reduce bias, foster trial replication, improve trial design and execution, and ultimately reduce research waste and help improve patient outcomes. Electronic supplementary material The online version of this article (10.1186/s13063-019-3248-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Peter Szatmari
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, Clinical Trials Platform, George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Caroline B Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sunita Vohra
- The Departments of Pediatrics, Medicine, and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - An-Wen Chan
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
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Tracey M, Rowney G, Pignatiello A, Monga S, Korczak D. FEASIBILITY OF A MANUALIZED FAMILY-BASED SUICIDE PREVENTION STRATEGY TO REDUCE ADOLESCENT SUICIDE RISK AMONG EMERGENCY DEPARTMENT REFERRED YOUTH: A QUALITY IMPROVEMENT PROJECT. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Suicide is the second leading cause of death among Canadian children and adolescents. Youth who present at an Emergency Department (ED) for suicidal ideation and risk behaviours (SRB) are at increased risk for eventual suicide. Despite this risk, current approaches to standard of care are referral to community resources or primary care where waitlists are common, and interventions may not be evidence-based or incorporate crisis management or family participation.
OBJECTIVES
To determine the feasibility and acceptability of a manualized, family-centered suicide prevention intervention administered in an outpatient clinic for ED-referred youth.
DESIGN/METHODS
Youth (aged 12 – 18) and parents presenting to the ED for SRB and referred to the Urgent Psychiatry Care clinic were eligible for the QI program, consisting of weekly individual and family sessions delivered over a 6-week period. The therapist addressed common symptoms and concerns of suicidal youth, sources of conflict within the family, and ways to improve communication and ensure patient safety. Patients were excluded if they did not have a parent or caregiver able to participate.
Suicidal ideation and behavior were assessed using youth-report measures, the Suicidal Ideation Questionnaire-Junior (SIQ-JR) and the Harkavy-Asnis Suicide Scale (HASS), at baseline and following program completion. The Mood and Feeling Questionnaire (MFQ) was used to measure depressive symptoms. Participant and therapist feedback was collected at follow-up using quantitative and qualitative measures.
RESULTS
Ten patients were enrolled and completed baseline measures, however four participants withdrew prior to 6 week completion: two withdrew at week 2 and one participant each withdrew at weeks 3 and 6. As such, 7/10 completed 5 weeks of the intervention. Significant improvement in both suicidal ideation (SIQ-JR, x̅ = -16.67; t(5) = 3.125, p = .026) and SRB (HASS, x̅ = -20.17; t(5) = 3.204, p = .024) were observed. Depressive symptoms also decreased (MFQ, x̅ = -15.5, t(5) = 2.724, p = .042). Youth and caregivers rated the program favorably. Improved family communication was most frequently reported by both patients and caregivers as a main benefit of the program.
CONCLUSION
These preliminary data indicate that SRB may be improved by a brief manualized, family-focused therapy. Early data suggest that the protocol is feasible and acceptable for adolescents presenting to the ED with safety concerns, and warrant further examination in a controlled trial.
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Affiliation(s)
| | | | - Antonio Pignatiello
- Department of Psychiatry, Hospital for Sick Children
- Department of Psychiatry, University of Toronto
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children
- Department of Psychiatry, University of Toronto
| | - Daphne Korczak
- Department of Psychiatry, Hospital for Sick Children
- Department of Psychiatry, University of Toronto
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Monga S. Brief guided parent-delivered CBT is both efficacious andcost-effective for childhood anxiety disorders. Evid Based Ment Health 2018; 21:e9. [PMID: 29650527 PMCID: PMC10270436 DOI: 10.1136/eb-2017-102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/09/2018] [Accepted: 03/05/2018] [Indexed: 11/04/2022]
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Monga S, Malik JN, Jan S, Bahadur S, Jetley S, Kaur H. Clinical study of extrapulmonary head and neck tuberculosis in an urban setting. Acta Otorhinolaryngol Ital 2018; 37:493-499. [PMID: 29327734 PMCID: PMC5782427 DOI: 10.14639/0392-100x-1252] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
Abstract
Tuberculosis (TB) of the head and neck region is quite common in endemic countries, but is still misdiagnosed due to its varied presentation and different sites of involvement. The aims of the present study were to present the diversities of presentation of head and neck tuberculosis with the diagnostic predicaments faced during evaluation and to assess treatment response to anti-tubercular treatment (ATT). We analysed 48 patients with head and neck tuberculosis who presented to the Department of Otorhinolaryngology in our tertiary care urban hospital over a period of two years from 2013 to 2015 and recorded their data, which included presenting complaints, local and systemic examination findings, investigation results and treatment outcomes. The results showed that majority (64.5%) of cases were female and none of the patients were HIV positive. The most common manifestation was cervical lymphadenopathy (81.25%) with level II being the most commonly affected (31.3%). Three of the 48 patients had coexisting pulmonary TB. Fine needle aspiration cytology (FNAC), histopathological diagnosis and acid fast bacilli (AFB) staining were used to confirm diagnosis. All patients were treated with Category I ATT, which achieved cure in 96.8% of cases. Though cervical lymphadenitis is the most common presentation of head and neck TB, isolated involvement of the sinonasal region, larynx, oral cavity and other sub-sites are not solely unknown entities. It is, therefore, important for clinicians to be aware of atypical and misleading presentations and consider TB as a major differential diagnosis in the head and neck region, even in non-immunocompromised individuals.
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Affiliation(s)
- S Monga
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - J N Malik
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - S Jan
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - S Bahadur
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - S Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - H Kaur
- Department of Computer Science & Engineering, Jamia Hamdard University, Delhi, India
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Affiliation(s)
- S. Monga
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
| | - R. Sachdeva
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
| | - A. Kochhar
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
| | - K. Banga
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
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Sashidhar K, Gulati M, Gupta D, Monga S, Suri S. Emphysema in heavy smokers with normal chest radiography: Detection and quantification by HRCT. Acta Radiol 2016; 43:60-5. [PMID: 11972464 DOI: 10.1080/028418502127347457] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine the severity and extent of emphysema in heavy smokers by high-resolution CT (HRCT) and to correlate the findings with spirometric tests (STs) and symptomatology. Material and Methods: Fifty adult smokers with a mean age of 53 years with a smoking history of more than 30 pack years and normal chest radiographs underwent HRCT of the chest and ST (FEV1, FEV1/FVC, PEFR). Among these, 22 had symptoms of pulmonary disease and 28 were asymptomatic. Quantification of emphysema was done using a density mask program and the visual scoring method. The results were correlated with ST and symptomatology. Results: 58% (29 out of 50) of the subjects had significant emphysema on HRCT. Eleven out of 15 with normal ST showed emphysema on HRCT while 2 with airflow obstruction on ST showed normal CT scores. 14% (4 out of 28) asymptomatic subjects had severe emphysema compared to 64% of symptomatic subjects. Emphysematous changes were predominantly seen in upper lung zones in 48% of the patients while in 52% it was distributed equally in both upper and lower zones. The number of pack years of smoking showed a positive correlation with CT scores. The correlation between HRCT scores and ST was statistically significant. Conclusion: A significant number of asymptomatic and clinically undiagnosed smokers tend to have significant emphysema. HRCT helps in early detection of disease and thus helps implementation of preventive measures.
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Affiliation(s)
- K Sashidhar
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Jovanovic M, Monga S, Korczak D, Grewal S. Child and Adolescent Online Mental Health Information: Parent and Adolescent Perspectives to Inform Development of Canadian Mental Health E-Resources for Paediatrics. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e80a] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Parents and adolescents are searching online for information about mental health. Google searches are frequently used, but do not always yield accurate and reliable information that is presented in a user-friendly manner. The first step toward the development of a useful online child mental health resource is to examine existing web content and understand parent and adolescent needs from online mental health material.
OBJECTIVES: The objectives of this study are two-fold (i) To conduct an environmental scan of existing online repositories of child and adolescent mental health information with respect to both parent and adolescent friendly content on three identified topic areas for the initial phase of the project (Anxiety, Eating Disorders, Suicide Prevention) (ii) To determine parent and adolescent needs from, and perspectives about, current web-based information with respect to site design, content and limitations to inform the creation of a pediatric hospital based web site with a broad range of information pertaining to child and adolescent mental health.
DESIGN/METHODS: An environmental scan was conducted to assess available online information about three identified topic areas as described above. As the project continues, the scan will be expanded to include other topic areas in child and adolescent mental health. Parallel parent needs assessment surveys were conducted. As our adolescent section was being developed, adolescents were surveyed for their feedback regarding illustrations and presentation of current content.
RESULTS: The environmental scan identified 17 hospital websites for in-depth review. Although some websites had information on diverse mental health topics, few contained comprehensive information on a broad range of topics. For example, only 9 had information about anxiety disorders. Additionally, an overall lack of adolescent specific content was noted. Parent surveys revealed significant interest in a strong stand-alone site where they could access mental health information. Parents also indicated that they would prefer separate parent and teen content areas.
CONCLUSION: Current websites providing information regarding child and adolescent mental health, while plentiful, lack sufficient scope, adolescent-friendly content, and interactivity that limit their utility for parents and families. Development of a high-quality and accessible child and adolescent mental health website requires an interdisciplinary collaboration of experts in mental health, website design, and knowledge dissemination. This study has informed the development of a new online resource, interactive elements of which will be shared as part of the oral presentation.
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Monga S, Rosenbloom BN, Tanha A, Owens M, Young A. Comparison of child-parent and parent-only cognitive-behavioral therapy programs for anxious children aged 5 to 7 years: short- and long-term outcomes. J Am Acad Child Adolesc Psychiatry 2015; 54:138-46. [PMID: 25617254 DOI: 10.1016/j.jaac.2014.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 04/20/2014] [Revised: 10/01/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Childhood anxiety disorders (AD) are prevalent, debilitating disorders. The most effective treatment approach for children less than 8 years old requires further investigation. The study's primary objective was to compare 2 cognitive-behavioral therapy (CBT) group programs. CBT was delivered to children 5 to 7 years old and their parents (child-parent) or only to parents (parent-only), whereas children attended group sessions but did not receive CBT. METHOD Using a prospective, repeated measures, longitudinal study design, 77 children (29 male, mean age = 6.8 years; SD = 0.8 year) with AD and their parents participated in either a 12-week child-parent or parent-only CBT group treatment after a 3-month no-treatment wait-time. Well-validated treatment outcome measures were completed at 5 assessment time points: initial assessment, pretreatment, immediately posttreatment, 6 months, and 12 months posttreatment. A mixed models analysis was used to assess change in AD severity and global functioning improvements from baseline within each treatment and between treatments. RESULTS No significant changes were noted in child-parent or parent-only treatment during the 3-month no-treatment wait time. Both treatments saw significant improvements posttreatment and at longer-term follow-up with significant reductions in AD severity measured by clinician and parent report and increases in global functioning. Significantly greater improvements were observed in the child-parent compared to the parent-only treatment. CONCLUSION This study suggests that both parent-only and child-parent group CBT improves AD severity in children 5 to 7 years old. Study results suggest that involvement of both children and parents in treatment is more efficacious than working with parents alone.
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Affiliation(s)
- Suneeta Monga
- Hospital for Sick Children (HSC) and the University of Toronto in Toronto, Canada.
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Adler Nevo GW, Avery D, Fiksenbaum L, Kiss A, Mendlowitz S, Monga S, Manassis K. Eight years later: outcomes of CBT-treated versus untreated anxious children. Brain Behav 2014; 4:765-74. [PMID: 25328851 PMCID: PMC4188368 DOI: 10.1002/brb3.274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders of childhood, generate significant distress, are considered precursors to diverse psychiatric disorders, and lead to poor social and employment outcomes in adulthood. Although childhood anxiety has a significant impact on a child's developmental trajectory, only a handful of studies examined the long-term impact of treatment and none included a control group. The aim of this study was to conduct a long-term follow-up (LTFU) of anxious children who were treated with Cognitive-Behavioral Therapy (CBT) compared to a matched group of children who were not. METHODS Subjects comprised 120 children: a treatment group which included the first 60 consecutive consenting children who were diagnosed with an anxiety disorder and treated with CBT between the years 1997 and 2003 and a control group, 60 matched children who were assessed but not treated with CBT. An "ex-post-facto" design was used to compare the two groups. RESULTS Children showed lower rates of anxiety diagnosis (about 50% for both groups) and significantly improved functioning at LTFU (time effect P < 0.0001; no group difference). Anxiety levels were significantly lower in the nontreatment group at LTFU as compared to initial assessment (P = 0.02), but not in the treatment group, and a significant between-group difference was found (P = 0.01) according to child. An inverse relationship was found between self-efficacy/self-esteem and anxiety outcome ([P = 0.0008] and [P = 0.04], respectively). CONCLUSIONS This study supports the assumption that childhood anxiety disorders may improve without treatment and highlights self-efficacy/self-esteem as potential factors in recovery.
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Affiliation(s)
- Gili W Adler Nevo
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - David Avery
- Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | | | - Alex Kiss
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - Sandra Mendlowitz
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Suneeta Monga
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Katharina Manassis
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
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Wilansky-Traynor P, Manassis K, Monga S, Shaw M, Merka P, Levac AM, Kleiman V. Cognitive behavioural therapy for depressed youth: predictors of attendance in a pilot study. J Can Acad Child Adolesc Psychiatry 2010; 19:81-87. [PMID: 20467543 PMCID: PMC2868553] [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] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 10/24/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Of the many forms of psychotherapy offered to treat depression in youth, Cognitive Behavioural Therapy (CBT) has been shown to be efficacious. Nonetheless, a high degree of apparent non-responsiveness, failure to remit post-treatment, and lack of long term benefit are all problematic. Given that regular participation is critical to treatment success, child and family predictors of attendance were researched. METHOD Twenty-nine depressed Canadian youth (aged 10-17) participated in a youth only or youth plus parent CBT group. Child and parent predictors of attendance were examined. RESULTS Youth who were younger, less anxious (by maternal report), and had more formally educated parents attended CBT more consistently. Further, mothers who perceived their children's depressive symptoms as more severe, whose children reported more depressive and anxious symptoms, and who reported more life stressors attended more parent sessions. CONCLUSIONS This study identifies key factors influencing youth and parent attendance in group CBT for depressed youth. Addressing these factors at the outset of treatment may decrease attrition in this form of psychotherapy.
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