Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2023.06.021
Joyce H.L. Lui PhD , Belinda C. Chen MA , Lisa A. Benson PhD , Yen-Jui R. Lin PhD , Amanda Ruiz MD , Anna S. Lau PhD
Objective
There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth.
Method
Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years.
Results
In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes.
Conclusion
Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.
Plain language summary
The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.
{"title":"Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth","authors":"Joyce H.L. Lui PhD , Belinda C. Chen MA , Lisa A. Benson PhD , Yen-Jui R. Lin PhD , Amanda Ruiz MD , Anna S. Lau PhD","doi":"10.1016/j.jaac.2023.06.021","DOIUrl":"10.1016/j.jaac.2023.06.021","url":null,"abstract":"<div><h3>Objective</h3><p><span><span>There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth </span>mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a </span>care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth.</p></div><div><h3>Method</h3><p>Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years.</p></div><div><h3>Results</h3><p>In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes.</p></div><div><h3>Conclusion</h3><p>Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.</p></div><div><h3>Plain language summary</h3><p>The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.</p></div>","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10313282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2024.04.003
Fabiano G. Nery MD, PhD
{"title":"Editorial: A Roadmap for Advancing the Field in Early-Onset Psychosis","authors":"Fabiano G. Nery MD, PhD","doi":"10.1016/j.jaac.2024.04.003","DOIUrl":"10.1016/j.jaac.2024.04.003","url":null,"abstract":"","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2024.04.002
Erica Smith MD
{"title":"You Are What You Eat: A Twin Experiment Review","authors":"Erica Smith MD","doi":"10.1016/j.jaac.2024.04.002","DOIUrl":"10.1016/j.jaac.2024.04.002","url":null,"abstract":"","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2024.03.013
Arash Javanbakht MD
Plain language summary
In this article, the author reflects upon recent advancements in artificial intelligence (AI) technologies have led to profound discussions about AI’s role in scientific research and education. AI technologies are now capable of summarizing and analyzing large volumes of data, creating presentations, and even drafting parts of scientific papers and grants with minimal human input. With their exponential ongoing advancements, they will become even more capable in doing these tasks. As boundaries between humans and AI blurs, serious questions arise about the future roles, responsibilities, and identity of academic researchers, intellectual property, publishing and grantsmanship, and equity in the world of AI potentiated research.
最近,我在微软技术中心讨论了我的实验室开发的用于治疗创伤后应激障碍(PTSD)的增强现实(AR)技术。我们还探讨了使用人工智能(AI)与数字 AR 角色进行自动交互的可能性。我们还参观了微软 365 Copilot 人工智能技术。这次经历,加上我即将体验的快速发展和公开可用的人工智能技术,引发了我对在科学工作和写作中使用人工智能的一系列问题和思考。
{"title":"In Context: AI Will Write Your Paper: The Very Different Future of Research and Scientific Writing in the Age of Artificial Intelligence","authors":"Arash Javanbakht MD","doi":"10.1016/j.jaac.2024.03.013","DOIUrl":"10.1016/j.jaac.2024.03.013","url":null,"abstract":"<div><h3>Plain language summary</h3><p>In this article, the author reflects upon recent advancements in artificial intelligence (AI) technologies have led to profound discussions about AI’s role in scientific research and education. AI technologies are now capable of summarizing and analyzing large volumes of data, creating presentations, and even drafting parts of scientific papers and grants with minimal human input. With their exponential ongoing advancements, they will become even more capable in doing these tasks. As boundaries between humans and AI blurs, serious questions arise about the future roles, responsibilities, and identity of academic researchers, intellectual property, publishing and grantsmanship, and equity in the world of AI potentiated research.</p></div>","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2023.09.544
Assia Riccioni MD , Joaquim Radua MD, PhD , Florence O. Ashaye BSc (Hons) , Marco Solmi MD , Samuele Cortese MD, PhD
Objective
To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates.
Method
We drew on, adapted, and updated the search of a network meta-analysis by Cortese et al. (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses.
Results
We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered.
Conclusion
More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research.
Plain language summary
A systematic review of 310 randomized controlled trials for attention-deficit/hyperactivity disorder (ADHD) medications found that race/ethnicity were reported in only 30% of trials. Compared to national estimates, Asian individuals were underrepresented and non-Hispanic Whites individuals were overrepresented, drawing attention to the inequities in participation in ADHD research.
Diversity & Inclusion Statement
One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
The author list of this paper includes contributors from
{"title":"Systematic Review and Meta-Analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications","authors":"Assia Riccioni MD , Joaquim Radua MD, PhD , Florence O. Ashaye BSc (Hons) , Marco Solmi MD , Samuele Cortese MD, PhD","doi":"10.1016/j.jaac.2023.09.544","DOIUrl":"10.1016/j.jaac.2023.09.544","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates.</p></div><div><h3>Method</h3><p>We drew on, adapted, and updated the search of a network meta-analysis by Cortese <em>et al.</em><span> (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses.</span></p></div><div><h3>Results</h3><p>We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered.</p></div><div><h3>Conclusion</h3><p>More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research.</p></div><div><h3>Plain language summary</h3><p>A systematic review of 310 randomized controlled trials for attention-deficit/hyperactivity disorder (ADHD) medications found that race/ethnicity were reported in only 30% of trials. Compared to national estimates, Asian individuals were underrepresented and non-Hispanic Whites individuals were overrepresented, drawing attention to the inequities in participation in ADHD research.</p></div><div><h3>Diversity & Inclusion Statement</h3><p>One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.</p><p>The author list of this paper includes contributors from","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2023.09.555
Aaron J. Hauptman MD, Jay A. Salpekar MD, Julie S. Cohen ScM, CGC, Miya R. Asato MD
{"title":"Navigating Neurogenetics for Child and Adolescent Psychiatry Practice","authors":"Aaron J. Hauptman MD, Jay A. Salpekar MD, Julie S. Cohen ScM, CGC, Miya R. Asato MD","doi":"10.1016/j.jaac.2023.09.555","DOIUrl":"10.1016/j.jaac.2023.09.555","url":null,"abstract":"","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2023.09.552
Jordan A. Freeman MPH , Jordan C. Farrar PhD , Matias Placencio-Castro MA , Alethea Desrosiers PhD , Robert T. Brennan EdD , Nathan B. Hansen PhD , Adeyinka M. Akinsulure-Smith PhD, ABPP , Shaobing Su PhD , Joseph Bangura MA , Theresa S. Betancourt ScD
Objective
Conflict-affected youth are at risk for poor psychological and social outcomes, yet few receive mental health services. Strategies to expand access and sustain evidence-based interventions (EBIs) across novel delivery platforms must be tested. The present study was a hybrid type II implementation-effectiveness trial using a cluster randomized design. The primary goal was to evaluate feasibility and impact of using the collaborative team approach to deliver the Youth Readiness Intervention (YRI), an EBI, integrated into a youth entrepreneurship program (ENTR) with quality control in post-conflict Sierra Leone.
Method
Youth were screened and randomly assigned to control, ENTR, or combined YRI and ENTR (YRI+ENTR). Implementation outcomes were dissemination and implementation indicators, competence, and fidelity. Effectiveness outcomes were emotion regulation, psychological distress, and interpersonal functioning. Secondary outcomes were third-party reporter assessments of youth functioning and behavior.
Results
Data were collected and analyzed from 1,151 youth participants and 528 third-party reporters. Scores on implementation constructs, competence, and fidelity demonstrated acceptable intervention response and quality. YRI+ENTR participants showed overall improvements in depression (β = −.081, 95% CI −0.124 to −0.038, d = −0.154) and anxiety (β = −.043, 95% CI −0.091 to −0.005, d = 0.082) symptoms compared with control participants. Community leaders indicated that YRI+ENTR participants demonstrated improvements in overall work or training performance compared with control participants (β = −.114, 95% CI 0.004 to 0.232, d = 0.374).
Conclusion
Integration of EBIs such as the YRI into youth employment programs has the potential to address limited reach of EBIs in conflict and post-conflict settings. A collaborative team implementation approach can facilitate integration and fidelity.
Plain language summary
In a Hybrid Type-II Implementation-Effectiveness trial conducted in Sierra Leone, researchers tested a Collaborative Team Approach (CTA) for delivering an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), within a youth entrepreneurship program. A total of 1,151 youth participated in the study, with outcomes measured on youth mental health indicators of emotional regulation, psychological distress, and interpersonal functioning, as well as implementation indicators, competence, and fidelity. Results demonstrated that the integrated YRI and entrepreneurship program led to significant improvements in depression and anxiety symptoms compared to the control group. Community leaders also noted enhanced overall performance in YRI participants, suggesting that integrating evidence-based interventions into youth employment programs can effectivel
目标受冲突影响的青少年面临着不良心理和社会后果的风险,但很少有人接受心理健康服务。必须测试在新的交付平台上扩大循证干预(EBI)的可及性和持续性的策略。本研究是一项采用分组随机设计的混合 II 型实施效果试验。主要目的是评估在冲突后的塞拉利昂使用协作团队方法提供青年准备干预(YRI)的可行性和影响,该方法是将循证干预整合到具有质量控制的青年创业计划(ENTR)中。实施结果包括传播和实施指标、能力和忠诚度。有效性结果包括情绪调节、心理困扰和人际功能。次要结果是第三方报告者对青少年功能和行为的评估。结果收集并分析了 1,151 名青少年参与者和 528 名第三方报告者的数据。对实施结构、能力和忠实性的评分表明,干预反应和质量是可以接受的。与对照组参与者相比,"YRI+ENTR "参与者的抑郁症状(β = -.081,95% CI -0.124至-0.038,d = -0.154)和焦虑症状(β = -.043,95% CI -0.091至-0.005,d = 0.082)总体有所改善。社区领导表示,与对照组参与者相比,"青年反应行动 "+ENTR参与者的总体工作或培训表现有所改善(β = -.114, 95% CI 0.004 to 0.232, d = 0.374)。在塞拉利昂进行的一项实施-效果混合型 II 类试验中,研究人员测试了在青年创业计划中实施循证心理健康干预--青年准备干预(YRI)的协作团队方法(CTA)。共有 1,151 名青年参与了这项研究,研究结果对青年心理健康指标(情绪调节、心理困扰和人际功能)以及实施指标、能力和忠诚度进行了测量。研究结果表明,与对照组相比,"青年研究与创新 "和创业综合计划显著改善了抑郁和焦虑症状。社区领导也注意到,青年就业项目参与者的整体表现有所提高,这表明将循证干预措施纳入青年就业项目可以有效解决资源匮乏地区的心理健康问题。我们努力确保以包容的方式编制研究问卷。在招募人类参与者时,我们努力确保种族、民族和/或其他类型的多样性。本论文的一位或多位作者自认为是一个或多个历史上在科学领域代表性不足的种族和/或民族群体的成员。本文的一位或多位作者自认为是一个或多个在科学界代表性不足的性和/或性别群体的成员。我们积极致力于促进作者群体的性别平衡。在我们的作者群中,我们积极致力于促进科学领域中历史上代表性不足的种族和/或民族群体的融入。本论文的作者名单包括来自研究所在地和/或社区的参与数据收集、设计、分析和/或解释工作的人员。本文的一位或多位作者获得了旨在提高少数民族在科学领域代表性的项目的支持。临床试验注册信息Youth FORWARD Phase 2 YRI and EPP Study; https://clinicaltrials.gov/; NCT03542500.研究预注册信息Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD):研究协议;https://doi.org/10.1176/appi.ps.202000009。
{"title":"Integrating Youth Readiness Intervention and Entrepreneurship in Sierra Leone: A Hybrid Type II Cluster Randomized Trial","authors":"Jordan A. Freeman MPH , Jordan C. Farrar PhD , Matias Placencio-Castro MA , Alethea Desrosiers PhD , Robert T. Brennan EdD , Nathan B. Hansen PhD , Adeyinka M. Akinsulure-Smith PhD, ABPP , Shaobing Su PhD , Joseph Bangura MA , Theresa S. Betancourt ScD","doi":"10.1016/j.jaac.2023.09.552","DOIUrl":"10.1016/j.jaac.2023.09.552","url":null,"abstract":"<div><h3>Objective</h3><p>Conflict-affected youth are at risk for poor psychological and social outcomes, yet few receive mental health services. Strategies to expand access and sustain evidence-based interventions (EBIs) across novel delivery platforms must be tested. The present study was a hybrid type II implementation-effectiveness trial using a cluster randomized design. The primary goal was to evaluate feasibility and impact of using the collaborative team approach to deliver the Youth Readiness Intervention (YRI), an EBI, integrated into a youth entrepreneurship program (ENTR) with quality control in post-conflict Sierra Leone.</p></div><div><h3>Method</h3><p>Youth were screened and randomly assigned to control, ENTR, or combined YRI and ENTR (YRI+ENTR). Implementation outcomes were dissemination and implementation indicators, competence, and fidelity. Effectiveness outcomes were emotion regulation<span>, psychological distress, and interpersonal functioning. Secondary outcomes were third-party reporter assessments of youth functioning and behavior.</span></p></div><div><h3>Results</h3><p>Data were collected and analyzed from 1,151 youth participants and 528 third-party reporters. Scores on implementation constructs, competence, and fidelity demonstrated acceptable intervention response and quality. YRI+ENTR participants showed overall improvements in depression (β = −.081, 95% CI −0.124 to −0.038, <em>d</em> = −0.154) and anxiety (β = −.043, 95% CI −0.091 to −0.005, <em>d</em><span> = 0.082) symptoms compared with control participants. Community leaders indicated that YRI+ENTR participants demonstrated improvements in overall work or training performance compared with control participants (β = −.114, 95% CI 0.004 to 0.232, </span><em>d</em> = 0.374).</p></div><div><h3>Conclusion</h3><p>Integration of EBIs such as the YRI into youth employment programs has the potential to address limited reach of EBIs in conflict and post-conflict settings. A collaborative team implementation approach can facilitate integration and fidelity.</p></div><div><h3>Plain language summary</h3><p>In a Hybrid Type-II Implementation-Effectiveness trial conducted in Sierra Leone, researchers tested a Collaborative Team Approach (CTA) for delivering an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), within a youth entrepreneurship program. A total of 1,151 youth participated in the study, with outcomes measured on youth mental health indicators of emotional regulation, psychological distress, and interpersonal functioning, as well as implementation indicators, competence, and fidelity. Results demonstrated that the integrated YRI and entrepreneurship program led to significant improvements in depression and anxiety symptoms compared to the control group. Community leaders also noted enhanced overall performance in YRI participants, suggesting that integrating evidence-based interventions into youth employment programs can effectivel","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2024.06.003
Matti Cervin, Davíð R M A Højgaard, Sanne Jensen, Nor Christian Torp, Gudmundur Skarphedinsson, Judith Becker Nissen, Karin Melin, Davide Fausto Borrelli, Katja Anna Hybel, Per Hove Thomsen, Tord Ivarsson, Bernhard Weidle
Objective: Children and adolescents with obsessive-compulsive disorder (OCD) are at risk for long-term adversity, but factors influencing long-term outcomes are unclear. A general factor of psychopathology, often referred to as the p factor, captures variance shared by all mental disorders and has predicted long-term outcomes in youth with anxiety and depressive disorders. The p factor has never been examined in relation to outcomes in pediatric OCD. Here, we examine whether the p factor predicts 4 important outcomes over both short and long durations in youth with OCD.
Method: We used data from the Nordic Long-term OCD Treatment Study (NordLOTS), in which youth with OCD (N = 248, mean age = 12.83 years [SD = 2.72], 51.6% girls) received exposure-based cognitive-behavioral therapy. The p factor was estimated using parent-reported Child Behavior Checklist data at baseline and was examined in relation to clinician-rated OCD severity, clinician-rated psychosocial functioning, self-reported depressive symptoms, and self- and parent-reported quality of life directly after treatment and 1, 2, and 3 years after treatment.
Results: The p factor was associated with acute treatment outcomes for OCD severity and psychosocial functioning, but not for depressive symptoms and quality of life. For the long-term outcomes, the p factor was significantly associated with all outcomes except OCD severity. The p factor outperformed traditional psychiatric comorbidity as a predictor of long-term outcomes.
Conclusion: Youth with OCD who experience symptoms across multiple psychiatric domains have poorer long-term outcomes. Compared to traditional classification of psychiatric diagnoses, assessing psychopathology using a dimensional p factor approach may be advantageous for informing prognosis in pediatric OCD.
目的:患有强迫症(OCD)的儿童和青少年面临长期逆境的风险,但影响长期结果的因素尚不清楚。精神病理学的一个通用因子通常被称为p因子,它能捕捉到所有精神障碍的共同变异,并能预测患有焦虑症和抑郁症的青少年的长期结局。p 因子从未与小儿强迫症的预后相关联。在此,我们研究了 p 因子是否能预测患有强迫症的青少年在短期和长期内的四种重要结果:我们使用了北欧长期强迫症治疗研究(NordLOTS)的数据,在该研究中,患有强迫症的青少年(N=248,年龄:12.83 岁 [SD = 2.72],52.0% 为女孩)接受了基于暴露的认知行为疗法。根据基线时家长报告的《儿童行为检查表》数据估算出p因子,并在治疗后1年、2年和3年对临床医生评定的强迫症严重程度、临床医生评定的心理社会功能、自我报告的抑郁症状以及自我和家长报告的生活质量进行了研究:P因子与强迫症严重程度和社会心理功能的急性治疗结果有关,但与抑郁症状和生活质量无关。在长期疗效方面,除强迫症严重程度外,p因子与所有疗效均有显著相关性。在预测长期结果方面,p因子优于传统的精神病合并症:结论:青少年强迫症患者如果出现多个精神科领域的症状,其长期预后较差。与传统的精神病诊断分类相比,使用维度p因子方法评估精神病理学可能更有利于为小儿强迫症的预后提供信息。
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Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2023.09.547
Rebecca G. Brady BS , Shelby D. Leverett MS , Liliana Mueller BS , Michayla Ruscitti BA , Aidan R. Latham BS , Tara A. Smyser MS , Emily D. Gerstein PhD , Barbara B. Warner MD , Deanna M. Barch PhD , Joan L. Luby MD , Cynthia E. Rogers MD , Christopher D. Smyser MD, MSCI
Objective
Prenatal exposure to neighborhood crime has been associated with weaker neonatal frontolimbic connectivity; however, associations with early childhood behavior remain unclear. We hypothesized that living in a high-crime neighborhood would be related to higher externalizing symptoms at age 1 and 2 years, over and above other adversities, and that neonatal frontolimbic connectivity and observed parenting behaviors at 1 year would mediate this relationship.
Method
Participants included 399 pregnant women, recruited as part of the Early Life Adversity, Biological Embedding, and Risk for Developmental Precursors of Mental Disorders (eLABE) study. Geocoded neighborhood crime data was obtained from Applied Geographic Solution. A total of 319 healthy, non-sedated neonates underwent scanning using resting-state functional magnetic resonance imaging (fMRI) on a Prisma 3T scanner and had ≥10 minutes of high-quality data. Infant–Toddler Socioemotional Assessment Externalizing T scores were available for 274 mothers of 1-year-olds and 257 mothers of 2-year-olds. Observed parenting behaviors were available for 202 parent–infant dyads at 1 year. Multilevel and mediation models tested longitudinal associations.
Results
Living in a neighborhood with high violent (β = 0.15, CI = 0.05-0.27, p = .004) and property (β = 0.10, CI = 0.01-0.20, p = .039) crime was related to more externalizing symptoms at 1 and 2 years, controlling for other adversities. Weaker frontolimbic connectivity was also associated with higher externalizing symptoms at 1 and 2 years. After controlling for other adversities, parenting behaviors mediated the specific association between crime and externalizing symptoms, but frontolimbic connectivity did not.
Conclusion
These findings provide evidence that early exposure to neighborhood crime and weaker neonatal frontolimbic connectivity may influence later externalizing symptoms, and suggest that parenting may be an early intervention target for families in high-crime areas.
Plain language summary
This longitudinal study of 399 women and their children found that toddlers who lived in a high crime area during the first 2 years of their lives displayed more externalizing symptoms. Toddlers with weaker frontolimbic brain function at birth also had higher externalizing symptoms at 1 and 2 years. Interestingly, parenting behaviors, but not neonatal brain function, mediated the relationship between neighborhood crime exposure and externalizing symptoms in toddlerhood.
Diversity & Inclusion Statement
We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-i
{"title":"Neighborhood Crime and Externalizing Behavior in Toddlers: A Longitudinal Study With Neonatal fMRI and Parenting","authors":"Rebecca G. Brady BS , Shelby D. Leverett MS , Liliana Mueller BS , Michayla Ruscitti BA , Aidan R. Latham BS , Tara A. Smyser MS , Emily D. Gerstein PhD , Barbara B. Warner MD , Deanna M. Barch PhD , Joan L. Luby MD , Cynthia E. Rogers MD , Christopher D. Smyser MD, MSCI","doi":"10.1016/j.jaac.2023.09.547","DOIUrl":"10.1016/j.jaac.2023.09.547","url":null,"abstract":"<div><h3>Objective</h3><p><span>Prenatal exposure to neighborhood crime has been associated with weaker neonatal frontolimbic connectivity; however, associations with early childhood behavior remain unclear. We hypothesized that living in a high-crime neighborhood would be related to higher externalizing </span>symptoms at age 1 and 2 years, over and above other adversities, and that neonatal frontolimbic connectivity and observed parenting behaviors at 1 year would mediate this relationship.</p></div><div><h3>Method</h3><p><span>Participants included 399 pregnant women, recruited as part of the Early Life Adversity, Biological Embedding, and Risk for Developmental Precursors of Mental Disorders<span> (eLABE) study. Geocoded neighborhood crime data was obtained from Applied Geographic Solution. A total of 319 healthy, non-sedated neonates underwent scanning using resting-state functional magnetic resonance imaging (fMRI) on a Prisma 3T scanner and had ≥10 minutes of high-quality data. Infant–Toddler Socioemotional Assessment Externalizing </span></span><em>T</em> scores were available for 274 mothers of 1-year-olds and 257 mothers of 2-year-olds. Observed parenting behaviors were available for 202 parent–infant dyads at 1 year. Multilevel and mediation models tested longitudinal associations.</p></div><div><h3>Results</h3><p>Living in a neighborhood with high violent (β = 0.15, CI = 0.05-0.27, <em>p</em> = .004) and property (β = 0.10, CI = 0.01-0.20, <em>p</em> = .039) crime was related to more externalizing symptoms at 1 and 2 years, controlling for other adversities. Weaker frontolimbic connectivity was also associated with higher externalizing symptoms at 1 and 2 years. After controlling for other adversities, parenting behaviors mediated the specific association between crime and externalizing symptoms, but frontolimbic connectivity did not.</p></div><div><h3>Conclusion</h3><p>These findings provide evidence that early exposure to neighborhood crime and weaker neonatal frontolimbic connectivity may influence later externalizing symptoms, and suggest that parenting may be an early intervention target for families in high-crime areas.</p></div><div><h3>Plain language summary</h3><p>This longitudinal study of 399 women and their children found that toddlers who lived in a high crime area during the first 2 years of their lives displayed more externalizing symptoms. Toddlers with weaker frontolimbic brain function at birth also had higher externalizing symptoms at 1 and 2 years. Interestingly, parenting behaviors, but not neonatal brain function, mediated the relationship between neighborhood crime exposure and externalizing symptoms in toddlerhood.</p></div><div><h3>Diversity & Inclusion Statement</h3><p>We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-i","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138550934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jaac.2024.02.008
Samuele Cortese MD , David Coghill MD , Gregory W. Mattingly MD , Luis Augusto Rohde MD, PhD , Robyn P. Thom MD , Timothy E. Wilens MD , Ian C.K. Wong PhD , Stephen V. Faraone PhD
{"title":"AACAP Endorses the Inclusion of Methylphenidate in the WHO Model Lists of Essential Medicines","authors":"Samuele Cortese MD , David Coghill MD , Gregory W. Mattingly MD , Luis Augusto Rohde MD, PhD , Robyn P. Thom MD , Timothy E. Wilens MD , Ian C.K. Wong PhD , Stephen V. Faraone PhD","doi":"10.1016/j.jaac.2024.02.008","DOIUrl":"10.1016/j.jaac.2024.02.008","url":null,"abstract":"","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":null,"pages":null},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140012824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}