Pub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.07.003
Chuan-Mei Lee MD, MA , Juliet Yonek PhD, MPH , Brendon Lin BA , Matthew Bechelli MD , Petra Steinbuchel MD , Lisa Fortuna MD, MPH, MDiv , Christina Mangurian MD, MAS
Objective
There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs.
Method
A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health.
Results
None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost (n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs.
Conclusion
Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs.
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 inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
Clinical trial registration information
Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410
{"title":"Systematic Review: Child Psychiatry Access Program Outcomes","authors":"Chuan-Mei Lee MD, MA , Juliet Yonek PhD, MPH , Brendon Lin BA , Matthew Bechelli MD , Petra Steinbuchel MD , Lisa Fortuna MD, MPH, MDiv , Christina Mangurian MD, MAS","doi":"10.1016/j.jaacop.2023.07.003","DOIUrl":"10.1016/j.jaacop.2023.07.003","url":null,"abstract":"<div><h3>Objective</h3><p>There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs.</p></div><div><h3>Method</h3><p>A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health.</p></div><div><h3>Results</h3><p>None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost (n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs.</p></div><div><h3>Conclusion</h3><p>Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs.</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 inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.</p></div><div><h3>Clinical trial registration information</h3><p>Child Psychiatry Access Programs: A Systematic Review; <span>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410</span><svg><path></path></svg>; CRD42020146410</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 154-172"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44689786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.06.003
Brandon J. Rennie PhD , Somer Bishop PhD , Bennett L. Leventhal MD , Shuting Zheng PhD , Ellen F. Geib PhD , Young Shin Kim MD, MS, MPH, PhD , Courtney Burnette PhD , Emma Salzman PsyD , Sara S. Nozadi PhD , Hosanna Kim MD , Whitney Ence PhD, BCBA-D , Mina Park PhD , Sheila Ghods MPH , Maria L. Welch BA , Debra MacKenzie PhD , Johnnye Lewis PhD, MA
Objective
Native American children disproportionally face many risk factors for poor developmental outcomes, including poverty, environmental toxicant exposure, and limited medical and intervention services. To understand these risks, comprehensive documentation of developmental and behavioral phenotypes is needed. In this descriptive study, the neurodevelopment of young Diné (Navajo) children was assessed using standardized assessment instruments in combination with expert clinician judgment.
Method
As part of an ongoing, population-based, prospective birth cohort study, comprehensive neurodevelopmental assessments were conducted of 138 Diné children 3 to 5 years old residing on or near the Navajo Nation. Standardized parent reports, psychiatric examinations, and direct assessments of children’s language, cognitive, adaptive, and social-emotional development, as well as best estimate clinical diagnoses were obtained.
Results
DSM-5 criteria for a neurodevelopmental disorder diagnosis were met by 49% of the sample. Language and speech sound disorders were most common, although autism spectrum disorder was also increased compared with the general population. Though language performance was low among all groups of children with and without neurodevelopmental disorders, children meeting criteria for certain neurodevelopmental disorders showed significantly lower performance on all language measures compared with children not meeting these criteria. Social-emotional, behavioral, and nonverbal cognitive ability were in the average range overall.
Conclusion
Diné children in this study were found to have a high percentage of clinically significant developmental delays. Overall, children presented with a pervasive pattern of depressed language performance across measures, irrespective of diagnosis (or no diagnosis), while other domains of functioning were similar to normative samples. Findings support the need to identify appropriate intervention and educational efforts for affected youth, while also exploring the causes of the specific developmental delays. However, longitudinal studies are necessary to establish best practices for identifying delays and delineating resilience factors to optimize development of Diné children.
{"title":"Neurodevelopmental Profiles of 4-Year-Olds in the Navajo Birth Cohort Study","authors":"Brandon J. Rennie PhD , Somer Bishop PhD , Bennett L. Leventhal MD , Shuting Zheng PhD , Ellen F. Geib PhD , Young Shin Kim MD, MS, MPH, PhD , Courtney Burnette PhD , Emma Salzman PsyD , Sara S. Nozadi PhD , Hosanna Kim MD , Whitney Ence PhD, BCBA-D , Mina Park PhD , Sheila Ghods MPH , Maria L. Welch BA , Debra MacKenzie PhD , Johnnye Lewis PhD, MA","doi":"10.1016/j.jaacop.2023.06.003","DOIUrl":"10.1016/j.jaacop.2023.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>Native American children disproportionally face many risk factors for poor developmental outcomes, including poverty, environmental toxicant exposure, and limited medical and intervention services. To understand these risks, comprehensive documentation of developmental and behavioral phenotypes is needed. In this descriptive study, the neurodevelopment of young Diné (Navajo) children was assessed using standardized assessment instruments in combination with expert clinician judgment.</p></div><div><h3>Method</h3><p>As part of an ongoing, population-based, prospective birth cohort study, comprehensive neurodevelopmental assessments were conducted of 138 Diné children 3 to 5 years old residing on or near the Navajo Nation. Standardized parent reports, psychiatric examinations, and direct assessments of children’s language, cognitive, adaptive, and social-emotional development, as well as best estimate clinical diagnoses were obtained.</p></div><div><h3>Results</h3><p><em>DSM-5</em> criteria for a neurodevelopmental disorder diagnosis were met by 49% of the sample. Language and speech sound disorders were most common, although autism spectrum disorder was also increased compared with the general population. Though language performance was low among all groups of children with and without neurodevelopmental disorders, children meeting criteria for certain neurodevelopmental disorders showed significantly lower performance on all language measures compared with children not meeting these criteria. Social-emotional, behavioral, and nonverbal cognitive ability were in the average range overall.</p></div><div><h3>Conclusion</h3><p>Diné children in this study were found to have a high percentage of clinically significant developmental delays. Overall, children presented with a pervasive pattern of depressed language performance across measures, irrespective of diagnosis (or no diagnosis), while other domains of functioning were similar to normative samples. Findings support the need to identify appropriate intervention and educational efforts for affected youth, while also exploring the causes of the specific developmental delays. However, longitudinal studies are necessary to establish best practices for identifying delays and delineating resilience factors to optimize development of Diné children.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 184-195"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47810327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.06.004
Katherine L. Guyon-Harris PhD , André Plamondon PhD , Kathryn L. Humphreys PhD, EdM , Mark Wade PhD , Mary Margaret Gleason MD , Florin Tibu PhD , Charles A. Nelson PhD , Nathan A. Fox PhD , Charles H. Zeanah MD
Objective
Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor.
Method
One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews.
Results
An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes.
Conclusion
General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count.
Clinical trial registration information
The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.
{"title":"Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample","authors":"Katherine L. Guyon-Harris PhD , André Plamondon PhD , Kathryn L. Humphreys PhD, EdM , Mark Wade PhD , Mary Margaret Gleason MD , Florin Tibu PhD , Charles A. Nelson PhD , Nathan A. Fox PhD , Charles H. Zeanah MD","doi":"10.1016/j.jaacop.2023.06.004","DOIUrl":"10.1016/j.jaacop.2023.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor.</p></div><div><h3>Method</h3><p>One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews.</p></div><div><h3>Results</h3><p>An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes.</p></div><div><h3>Conclusion</h3><p>General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count.</p></div><div><h3>Clinical trial registration information</h3><p>The Bucharest Early Intervention Project; <span>https://clinicaltrials.gov/</span><svg><path></path></svg>; NCT00747396.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 173-183"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48573849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.09.003
Robert R. Althoff MD, PhD (Associate Editor), Manpreet K. Singh MD, MS (Editor), Kara S. Bagot MD, Daniel P. Dickstein MD, FAAP, Stacy S. Drury MD, PhD, FAPA, Robert L. Findling MD, MBA (Deputy Editors), Mary K. Billingsley ELS (Managing Editor)
{"title":"Peer Review in JAACAP Open: Promoting Integrity While Advancing Open Science","authors":"Robert R. Althoff MD, PhD (Associate Editor), Manpreet K. Singh MD, MS (Editor), Kara S. Bagot MD, Daniel P. Dickstein MD, FAAP, Stacy S. Drury MD, PhD, FAPA, Robert L. Findling MD, MBA (Deputy Editors), Mary K. Billingsley ELS (Managing Editor)","doi":"10.1016/j.jaacop.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.jaacop.2023.09.003","url":null,"abstract":"","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 151-153"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71783855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.06.002
Naomi O. Davis PhD , Kelley A. Jones PhD , Alexis French PhD , Melissa A. Greiner MS , Chris Ricard Lea MD , Courtney L. McMickens MD, MPH, MHS , Nicole Heilbron PhD , Gary R. Maslow MD, MPH
Objective
Youth depression is increasing and is associated with adverse concurrent and long-term outcomes. Understanding receipt of depression treatment and outcomes is critical for population-level efforts to address youth depression. This study aimed to understand treatment patterns and their association with depression-related outcomes.
Method
North Carolina Medicaid claims were used to conduct a retrospective cohort study of treatment and depression-related outcomes in pediatric Medicaid beneficiaries. The sample included 34,623 youth ages 5 to 21 years with an incident depression diagnosis. Psychotherapy and antidepressant medication were assessed for 6 months following diagnosis. Depression-related outcomes including suicidal or self-harming behaviors, emergency department use, and psychiatric hospitalization were analyzed using Cox proportional hazards models to calculate hazard ratios.
Results
Among youth with depression, 86% received treatment (39% psychotherapy, 16% medication, 31% combined), but few youth received guideline-recommended treatment duration. At 6 and 18 months, youth who received combined treatment had higher risk of adverse outcomes compared with the other groups. The untreated group had lower risk of outcomes other than all-cause emergency department visits. Single-session psychotherapy and inconsistent medication fills were also associated with poor outcomes; however, more psychotherapy sessions were associated with lower risk of all-cause emergency department visits.
Conclusion
These data show that the majority of youth who received depression treatment had suboptimal adherence to recommended guidelines. Youth who received combined treatment (both medication and therapy) had more adverse depression outcomes. As claims records do not include clinical data, the effect of treatment type, dose, depression severity, or a combination of these factors cannot be readily disentangled; therefore, these findings do not support a conclusion that combined treatment leads to poor outcomes. Rather, it is possible that youth with a more severe clinical profile are more likely to be prescribed combined treatment or to have poor adherence and thus worse outcomes. Understanding how to improve adherence in real-world settings is needed. Results suggest that many youth continue to struggle despite receipt of mental health care, indicating a call for enhancing existing treatment strategies. Research should aim to better understand population-level care for depression and to promote receipt of and adherence to recommended treatment duration across modalities.
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. One or more of the authors of this paper self-identifies as a member of one or mor
{"title":"Treatment and Outcomes Among North Carolina Medicaid-Insured Youth With Depression","authors":"Naomi O. Davis PhD , Kelley A. Jones PhD , Alexis French PhD , Melissa A. Greiner MS , Chris Ricard Lea MD , Courtney L. McMickens MD, MPH, MHS , Nicole Heilbron PhD , Gary R. Maslow MD, MPH","doi":"10.1016/j.jaacop.2023.06.002","DOIUrl":"10.1016/j.jaacop.2023.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>Youth depression is increasing and is associated with adverse concurrent and long-term outcomes. Understanding receipt of depression treatment and outcomes is critical for population-level efforts to address youth depression. This study aimed to understand treatment patterns and their association with depression-related outcomes.</p></div><div><h3>Method</h3><p>North Carolina Medicaid claims were used to conduct a retrospective cohort study of treatment and depression-related outcomes in pediatric Medicaid beneficiaries. The sample included 34,623 youth ages 5 to 21 years with an incident depression diagnosis. Psychotherapy and antidepressant medication were assessed for 6 months following diagnosis. Depression-related outcomes including suicidal or self-harming behaviors, emergency department use, and psychiatric hospitalization were analyzed using Cox proportional hazards models to calculate hazard ratios.</p></div><div><h3>Results</h3><p>Among youth with depression, 86% received treatment (39% psychotherapy, 16% medication, 31% combined), but few youth received guideline-recommended treatment duration. At 6 and 18 months, youth who received combined treatment had higher risk of adverse outcomes compared with the other groups. The untreated group had lower risk of outcomes other than all-cause emergency department visits. Single-session psychotherapy and inconsistent medication fills were also associated with poor outcomes; however, more psychotherapy sessions were associated with lower risk of all-cause emergency department visits.</p></div><div><h3>Conclusion</h3><p>These data show that the majority of youth who received depression treatment had suboptimal adherence to recommended guidelines. Youth who received combined treatment (both medication and therapy) had more adverse depression outcomes. As claims records do not include clinical data, the effect of treatment type, dose, depression severity, or a combination of these factors cannot be readily disentangled; therefore, these findings do not support a conclusion that combined treatment leads to poor outcomes. Rather, it is possible that youth with a more severe clinical profile are more likely to be prescribed combined treatment or to have poor adherence and thus worse outcomes. Understanding how to improve adherence in real-world settings is needed. Results suggest that many youth continue to struggle despite receipt of mental health care, indicating a call for enhancing existing treatment strategies. Research should aim to better understand population-level care for depression and to promote receipt of and adherence to recommended treatment duration across modalities.</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. One or more of the authors of this paper self-identifies as a member of one or mor","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 196-205"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48913920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jaacop.2023.07.001
Manpreet K. Singh MD, MS (Editor), Robert R. Althoff MD, PhD (Associate Editor), Kara S. Bagot MD, Daniel P. Dickstein MD, FAAP, Stacy S. Drury MD, PhD, FAPA, Robert L. Findling MD, MBA (Deputy Editors), Mary K. Billingsley ELS (Managing Editor), Douglas K. Novins MD (JAACAP Editor-in-Chief)
{"title":"Our Hopes for JAACAP Open","authors":"Manpreet K. Singh MD, MS (Editor), Robert R. Althoff MD, PhD (Associate Editor), Kara S. Bagot MD, Daniel P. Dickstein MD, FAAP, Stacy S. Drury MD, PhD, FAPA, Robert L. Findling MD, MBA (Deputy Editors), Mary K. Billingsley ELS (Managing Editor), Douglas K. Novins MD (JAACAP Editor-in-Chief)","doi":"10.1016/j.jaacop.2023.07.001","DOIUrl":"10.1016/j.jaacop.2023.07.001","url":null,"abstract":"","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 2","pages":"Pages 77-79"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49542994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children’s experiences of peer victimization and peer aggression are strongly linked to their mental health. However, we do not know how this relationship is influenced by periods of restricted and unrestricted social interactions. In this study, we investigated the following: (1) the bidirectional association between children’s peer problems and mental health; (2) individual differences in the joint development of peer victimization, peer aggression, and mental health; and (3) factors associated with joint trajectories over 13 months during the COVID-19 pandemic in the United Kingdom.
Method
Our sample consisted of 2,160 children 4 to 10 years of age for whom parents or carers/caregivers completed a baseline and at least 1 follow-up online survey between March 2020 and May 2021 as part of the COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) study. We used generalized linear models to examine bidirectional associations, group-based trajectory modeling to map joint trajectories, and multinomial logistic regressions to identify factors associated with trajectories.
Results
Experiencing mental health difficulties during school closures increased the risk of experiencing peer victimization, but not peer aggression on return to school. Experiencing any peer problems during school closures did not predict subsequent mental health difficulties. The majority of children followed joint trajectories of low exposure to peer problems and mental health; however 16% to 17% of our sample followed joint trajectories of high exposure to peer problems and mental health. Low family income, family conflict, parental distress, special educational needs, and lack of friendships were associated with high exposure mental health and peer problem trajectories.
Conclusion
Increasing children’s mental health support during periods of isolation may not only reduce concurrent and future mental health problems but may also prevent subsequent peer problems for both vulnerable and non-vulnerable children.
Study preregistration information
Co-SPACE (Covid-19: Supporting Parents, Adolescents and Children during Epidemics); https://osf.io/.
儿童遭受同伴伤害和同伴攻击的经历与他们的心理健康密切相关。然而，我们不知道这种关系是如何受到限制和不受限制的社会互动时期的影响的。本研究主要探讨:(1)儿童同伴问题与心理健康的双向关系;(2)同伴伤害、同伴攻击与心理健康共同发展的个体差异;(3)与英国COVID-19大流行期间13个月联合轨迹相关的因素。我们的样本包括2160名4至10岁的儿童，他们的父母或照顾者/照顾者在2020年3月至2021年5月期间完成了一项基线调查和至少1项后续在线调查，作为COVID-19:流行病期间支持父母、青少年和儿童(Co-SPACE)研究的一部分。我们使用广义线性模型来检验双向关联，使用基于群体的轨迹建模来映射联合轨迹，使用多项逻辑回归来识别与轨迹相关的因素。结果学校关闭期间的心理健康问题增加了学生返校后遭受同伴侵害的风险，但没有增加同伴攻击的风险。在学校关闭期间遇到任何同伴问题并不能预示随后的心理健康问题。大多数儿童遵循低暴露于同伴问题和心理健康的共同轨迹;然而，在我们的样本中，有16%到17%的人同时存在同伴问题和心理健康问题。家庭收入低、家庭冲突、父母痛苦、特殊教育需要和缺乏友谊与高暴露心理健康和同伴问题轨迹有关。结论在孤立期增加儿童的心理健康支持不仅可以减少当前和未来的心理健康问题，还可以预防继发的同伴问题。研究注册前信息co - space (Covid-19:在流行病期间支持父母、青少年和儿童);https://osf.io/。
{"title":"What Happens to Children’s Mental Health and Peer Relationships During Periods of Restricted and Unrestricted Social Interactions? Results From the Co-SPACE Study in Primary School-Aged Children","authors":"Carolina Guzman Holst MSc, Sinziana I. Oncioiu PhD, Cathy Creswell PhD, Lucy Bowes PhD","doi":"10.1016/j.jaacop.2023.05.003","DOIUrl":"10.1016/j.jaacop.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>Children’s experiences of peer victimization and peer aggression are strongly linked to their mental health. However, we do not know how this relationship is influenced by periods of restricted and unrestricted social interactions. In this study, we investigated the following: (1) the bidirectional association between children’s peer problems and mental health; (2) individual differences in the joint development of peer victimization, peer aggression, and mental health; and (3) factors associated with joint trajectories over 13 months during the COVID-19 pandemic in the United Kingdom.</p></div><div><h3>Method</h3><p>Our sample consisted of 2,160 children 4 to 10 years of age for whom parents or carers/caregivers completed a baseline and at least 1 follow-up online survey between March 2020 and May 2021 as part of the COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) study. We used generalized linear models to examine bidirectional associations, group-based trajectory modeling to map joint trajectories, and multinomial logistic regressions to identify factors associated with trajectories.</p></div><div><h3>Results</h3><p>Experiencing mental health difficulties during school closures increased the risk of experiencing peer victimization, but not peer aggression on return to school. Experiencing any peer problems during school closures did not predict subsequent mental health difficulties. The majority of children followed joint trajectories of low exposure to peer problems and mental health; however 16% to 17% of our sample followed joint trajectories of high exposure to peer problems and mental health. Low family income, family conflict, parental distress, special educational needs, and lack of friendships were associated with high exposure mental health and peer problem trajectories.</p></div><div><h3>Conclusion</h3><p>Increasing children’s mental health support during periods of isolation may not only reduce concurrent and future mental health problems but may also prevent subsequent peer problems for both vulnerable and non-vulnerable children.</p></div><div><h3>Study preregistration information</h3><p>Co-SPACE (Covid-19: Supporting Parents, Adolescents and Children during Epidemics); <span>https://osf.io/</span><svg><path></path></svg>.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 2","pages":"Pages 128-140"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45232732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jaacop.2023.05.001
Michelle Sader BSc (Hons), PhD Candidate , Holly A. Harris PhD , Gordon D. Waiter PhD , Margaret C. Jackson PhD , Trudy Voortman PhD , Pauline W. Jansen PhD , Justin H.G. Williams MBBS, MSc, MD (Hons), FRANZCP
Objective
Avoidant/restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder category in DSM-5 characterized by extreme food avoidance/restriction. Much is unknown about ARFID, with limited understanding of its prevalence and comorbidities in general pediatric populations. This study aimed to classify ARFID prevalence and characteristics in children within the Generation R Study, a population-based Dutch cohort (N = 2,862).
Method
ARFID was assessed via an Index that comprised parent-reported questionnaires and researcher-assessed measures of picky eating, energy intake, diet quality, growth, and psychosocial impact, all in the absence of body/weight dissatisfaction to align with DSM-5 criteria. Parents also reported on child appetitive traits and emotional/behavioral problems (eg, anxiety, depression, attention problems).
Results
Using DSM-5–based categorization, 183 (6.4%) of 2,862 children were classified as presenting with ARFID symptoms. Compared with children not exhibiting symptoms, children classified with ARFID symptomatology expressed other avoidant eating behavior, including decreased enjoyment of food (d = −1.06, false discovery rate–corrected p [pFDR] < .001), increased satiety responsiveness (d = 1.06, pFDR < .001), and emotional undereating (d = 0.21, pFDR < .01), as well as more emotional problems, including withdrawn/depressed (d = 0.38, pFDR < .001), social problems (d = 0.34, pFDR < 0.001), attention problems (d = 0.38, pFDR < .001), anxiety (d = 0.30, pFDR < .001), obsessive/compulsive problems (d = 0.15, pFDR < .05), and autistic traits (d = 0.22; pFDR < .05). Associations did not differ by sex.
Conclusion
This is the first large-scale community-based study to characterize ARFID and to demonstrate that ARFID symptom classification is common in children aged ≤10 years. Findings suggest that appetitive, emotional, and behavioral comorbidities may underlie or reinforce the presentation of ARFID.
Diversity & Inclusion Statement
We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Diverse cell lines and/or genomic datasets were not available. 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 the location and/or community
{"title":"Prevalence and Characterization of Avoidant Restrictive Food Intake Disorder in a Pediatric Population","authors":"Michelle Sader BSc (Hons), PhD Candidate , Holly A. Harris PhD , Gordon D. Waiter PhD , Margaret C. Jackson PhD , Trudy Voortman PhD , Pauline W. Jansen PhD , Justin H.G. Williams MBBS, MSc, MD (Hons), FRANZCP","doi":"10.1016/j.jaacop.2023.05.001","DOIUrl":"10.1016/j.jaacop.2023.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>Avoidant/restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder category in <em>DSM-5</em> characterized by extreme food avoidance/restriction. Much is unknown about ARFID, with limited understanding of its prevalence and comorbidities in general pediatric populations. This study aimed to classify ARFID prevalence and characteristics in children within the Generation R Study, a population-based Dutch cohort (N = 2,862).</p></div><div><h3>Method</h3><p>ARFID was assessed via an Index that comprised parent-reported questionnaires and researcher-assessed measures of picky eating, energy intake, diet quality, growth, and psychosocial impact, all in the absence of body/weight dissatisfaction to align with <em>DSM-5</em> criteria. Parents also reported on child appetitive traits and emotional/behavioral problems (eg, anxiety, depression, attention problems).</p></div><div><h3>Results</h3><p>Using <em>DSM-5</em>–based categorization, 183 (6.4%) of 2,862 children were classified as presenting with ARFID symptoms. Compared with children not exhibiting symptoms, children classified with ARFID symptomatology expressed other avoidant eating behavior, including decreased enjoyment of food (<em>d</em> = −1.06, false discovery rate–corrected <em>p</em> [<em>p</em><sub>FDR</sub>] < .001), increased satiety responsiveness (<em>d</em> = 1.06, <em>p</em><sub>FDR</sub> < .001), and emotional undereating (<em>d</em> = 0.21, <em>p</em><sub>FDR</sub> < .01), as well as more emotional problems, including withdrawn/depressed (<em>d</em> = 0.38, <em>p</em><sub>FDR</sub> < .001), social problems (<em>d</em> = 0.34, <em>p</em><sub>FDR</sub> < 0.001), attention problems (<em>d</em> = 0.38, <em>p</em><sub>FDR</sub> < .001), anxiety (<em>d</em> = 0.30, <em>p</em><sub>FDR</sub> < .001), obsessive/compulsive problems (<em>d</em> = 0.15, <em>p</em><sub>FDR</sub> < .05), and autistic traits (<em>d</em> = 0.22; <em>p</em><sub>FDR</sub> < .05). Associations did not differ by sex.</p></div><div><h3>Conclusion</h3><p>This is the first large-scale community-based study to characterize ARFID and to demonstrate that ARFID symptom classification is common in children aged ≤10 years. Findings suggest that appetitive, emotional, and behavioral comorbidities may underlie or reinforce the presentation of ARFID.</p></div><div><h3>Diversity & Inclusion Statement</h3><p>We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Diverse cell lines and/or genomic datasets were not available. 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 the location and/or community ","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 2","pages":"Pages 116-127"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42778000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jaacop.2023.06.001
Mohamed Y. Elhosary MD , John A. Merranko MA , Tina R. Goldstein PhD , Danella M. Hafeman MD, PhD , Benjamin I. Goldstein MD, PhD , Mary Kay Gill MSN , Heather Hower MSW , David A. Axelson MD , Jeffrey I. Hunt MD , Shirley Yen PhD , Rasim Somer Diler MD , Neal D. Ryan MD , Martin B. Keller MD , Lauren M. Weinstock PhD , Michael Strober PhD , Boris Birmaher MD
Objective
To assess medication adherence and factors associated with poor adherence in youth with bipolar disorder followed from adolescence through young adulthood.
Method
Participants with bipolar disorder recruited through the Course and Outcome of Bipolar Youth (COBY) study were included in this study if they were prescribed psychotropic medications and had at least 3 follow-up assessments of medication adherence (N = 179, ages 12-36). Medication adherence had been evaluated for a median of 8 years using a questionnaire derived from the Coronary Artery Risk Development in Young Adults (CARDIA) study. For the longitudinal evaluation, adherence was measured as the percentage of follow-up assessments in which the participants did not endorse any of the nonadherence items included in the questionnaire. Concurrent and future predictors of poor adherence were assessed using both univariate and multivariate longitudinal analyses.
Results
Among the participants, 51% reported poor adherence in more than 50% of their follow-up assessments. Younger age, family conflicts, polypharmacy, lower functioning, greater severity of mood symptoms, and comorbid disorders were associated with poor adherence in the univariate analyses. In the multivariate analyses, comorbid attention-deficit/hyperactivity disorder was the single most influential factor associated with concurrent and future poor adherence in all age groups. Participants’ most reported reasons for poor adherence were forgetfulness (56%), negative attitudes toward medication treatment (10.5%), and disturbed daily routine (7%).
Conclusion
Poor medication adherence is a significant problem in youth with bipolar disorder, with the most influential factor being the presence of comorbid attention-deficit/hyperactivity disorder. Thus, it is important to identify and appropriately treat comorbid attention-deficit/hyperactivity disorder to improve medication adherence and prognosis of patients. Providers should also recommend tools to enhance consistent medication intake and address patients’ concerns and negative beliefs about their illness and treatment.
{"title":"Examining Factors Associated With Medication Adherence in Youth With Bipolar Disorder","authors":"Mohamed Y. Elhosary MD , John A. Merranko MA , Tina R. Goldstein PhD , Danella M. Hafeman MD, PhD , Benjamin I. Goldstein MD, PhD , Mary Kay Gill MSN , Heather Hower MSW , David A. Axelson MD , Jeffrey I. Hunt MD , Shirley Yen PhD , Rasim Somer Diler MD , Neal D. Ryan MD , Martin B. Keller MD , Lauren M. Weinstock PhD , Michael Strober PhD , Boris Birmaher MD","doi":"10.1016/j.jaacop.2023.06.001","DOIUrl":"10.1016/j.jaacop.2023.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>To assess medication adherence and factors associated with poor adherence in youth with bipolar disorder followed from adolescence through young adulthood.</p></div><div><h3>Method</h3><p>Participants with bipolar disorder recruited through the Course and Outcome of Bipolar Youth (COBY) study were included in this study if they were prescribed psychotropic medications and had at least 3 follow-up assessments of medication adherence (N = 179, ages 12-36). Medication adherence had been evaluated for a median of 8 years using a questionnaire derived from the Coronary Artery Risk Development in Young Adults (CARDIA) study. For the longitudinal evaluation, adherence was measured as the percentage of follow-up assessments in which the participants did not endorse any of the nonadherence items included in the questionnaire. Concurrent and future predictors of poor adherence were assessed using both univariate and multivariate longitudinal analyses.</p></div><div><h3>Results</h3><p>Among the participants, 51% reported poor adherence in more than 50% of their follow-up assessments. Younger age, family conflicts, polypharmacy, lower functioning, greater severity of mood symptoms, and comorbid disorders were associated with poor adherence in the univariate analyses. In the multivariate analyses, comorbid attention-deficit/hyperactivity disorder was the single most influential factor associated with concurrent and future poor adherence in all age groups. Participants’ most reported reasons for poor adherence were forgetfulness (56%), negative attitudes toward medication treatment (10.5%), and disturbed daily routine (7%).</p></div><div><h3>Conclusion</h3><p>Poor medication adherence is a significant problem in youth with bipolar disorder, with the most influential factor being the presence of comorbid attention-deficit/hyperactivity disorder. Thus, it is important to identify and appropriately treat comorbid attention-deficit/hyperactivity disorder to improve medication adherence and prognosis of patients. Providers should also recommend tools to enhance consistent medication intake and address patients’ concerns and negative beliefs about their illness and treatment.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 2","pages":"Pages 105-115"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49211445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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