Tag: Young People

Examining National Trends in the Care of Different Mental Health Problems & in Different Treatment Settings among Adolescents

Published on by Andrew Marshall1 Comment

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

Research Paper Title

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

Can Internet-Based CBT be used to Treat Young People with OCD?

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Research Paper Title

Online Obsessive-Compulsive Disorder Treatment: Preliminary Results of the “OCD? Not Me!” Self-Guided Internet-Based Cognitive Behavioral Therapy Program for Young People.

Background

The development and evaluation of Internet-delivered cognitive behavioral therapy (iCBT) interventions provides a potential solution for current limitations in the acceptability, availability, and accessibility of mental health care for young people with obsessive-compulsive disorder (OCD).

Preliminary results support the effectiveness of therapist-assisted iCBT for young people with OCD; however, no previous studies have examined the effectiveness of completely self-guided iCBT for OCD in young people.

The researches aimed to conduct a preliminary evaluation of the effectiveness of the OCD? Not Me! program for reducing OCD-related psychopathology in young people (12-18 years). This programme is an eight-stage, completely self-guided iCBT treatment for OCD, which is based on exposure and response prevention.

Methods

These data were early and preliminary results of a longer study in which an open trial design is being used to evaluate the effectiveness of the OCD? Not Me!

Participants were required to have at least subc-linical levels of OCD to be offered the online program. Participants with moderate-high suicide/self-harm risk or symptoms of eating disorder or psychosis were not offered the programme. OCD symptoms and severity were measured at pre- and post-test, and at the beginning of each stage of the programme. Data was analysed using generalised linear mixed models.

Results

A total of 334 people were screened for inclusion in the study, with 132 participants aged 12 to 18 years providing data for the final analysis.

Participants showed significant reductions in OCD symptoms (P<.001) and severity (P<.001) between pre- and post-test.

Conclusions

These preliminary results suggest that fully automated iCBT holds promise as a way of increasing access to treatment for young people with OCD; however, further research needs to be conducted to replicate the results and to determine the feasibility of the programme.

Reference

Rees, C.S., Anderson, R.A., Kane, R.T. & Finaly-Jones, A.L. (2016) Online Obsessive-Compulsive Disorder Treatment: Preliminary Results of the “OCD? Not Me!” Self-Guided Internet-Based Cognitive Behavioral Therapy Program for Young People. JMIR Mental Health. 3(3):e29. doi: 10.2196/mental.5363.

Intellectual Disabilities & Coexisting Mental Health Conditions

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Research Paper Title

Developmental stages and estimated prevalence of coexisting mental health and neurodevelopmental conditions and service use in youth with intellectual disabilities, 2011-2012.

Background

Few studies exist on mental health and neurodevelopmental conditions and service use among youth with intellectual disabilities (IDs), which makes it difficult to develop interventions for this population.

The objective of the study is to

  1. Estimate and compare the prevalence of mental health and neurodevelopmental conditions in youth with and without ID across three developmental stages; and
  2. Estimate and compare mental health service use in youth with and without ID across three developmental stages.

Methods

The researchers conducted secondary data analysis using cross-sectional data collected from caregivers completing the 2011-2012 National Survey of Children’s Health.

The data set represents a nationally representative sample of youth (0-17 years) in the USA with one child from each household being randomly selected.

Data were collected from caregivers in 50 states, Washington D.C. and the US Virgin Islands.

The researchers restricted the sample to parents of youth between 3-17 years (N = 81 510).

Results

Compared with youth without ID, youth ages 3-17 with ID had a statistically significantly higher prevalence of (1) mental health and neurodevelopmental conditions and (2) mental health care use and medication use for mental health and neurodevelopmental issues (other than attention deficit disorder/attention deficit hyperactivity disorder).

Clinically significant differences in coexisting conditions and service use were also found across developmental stages.

Conclusions

Youth with ID are at greater risk of having coexisting mental health and neurodevelopmental conditions than youth without ID and are more likely to receive treatment.

Therefore, clinicians should consider mental health and neurodevelopmental conditions and the unique needs of youth by developmental stage when tailoring interventions for youth with ID.

Reference

Comer-HaGans, D., Weller, B.E., Story, C. & Holton, J. (2020) Developmental stages and estimated prevalence of coexisting mental health and neurodevelopmental conditions and service use in youth with intellectual disabilities, 2011-2012. Journal of Intellectual Disability Research. 64(3), pp.185-196. doi: 10.1111/jir.12708. Epub 2020 Jan 1.

Have Antidepressant Prescriptions, Including Tricyclics, Increased in Canadian Children?

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Research Paper Title

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Background

Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004.

Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016.

Methods

A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of paediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians.

The term “recommendations” is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken.

The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian paediatric population.

Results

The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants.

Analysis indicated that fluoxetine was the most frequently recommended drug.

Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression.

Conclusions

Overall, antidepressant use in Canadian children increased over the study period.

Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children.

However, the observed increase in TCA use for a paediatric population is unexpected.

The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Reference

Lukmanji, A., Pringsheim, T., Bulloch, A.G., Stewart, D.G., Chan, P., Tehrani, A. & Patten, S.B. (2020) Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children. Journal of Child and Adolescent Psychopharmacology. doi: 10.1089/cap.2019.0121. [Epub ahead of print].

A Review into Effective & Cost Effective Interventions of Child Mental Health Problems

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Research Paper Title

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

Background

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods

The researchers will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS.

They will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations.

Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process.

They will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical ad/or functional outcomes) and which have been delivered to young people in LAMICs.

They will also consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils).

In the pilot of screening procedures, 5% of all references will be screened by two reviewers.

Divergences will be resolved by one expert in mental health research.

Reviewers will be retrained afterwards to ensure reliability.

The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

The results will be presented descriptively and, if possible, meta-analysis will be conducted.

Ethical approval is not needed for anonymised secondary data.

Conclusions

The systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Reference

Grande, A.J., Ribeiro, W.S., Faustino, C., de Miranda, C.T., Mcdaid, D., Fry, A., de Moraes, S.H.M., de Oliveira, S.M.D.V.L., de Farias, J.M., de Tarso Coelho Jardim, P., King, D., Silva, V., Ziebold, C. & Evans-Lacko, S. (2020) Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review. Medicine (Baltimore). 99(1):e18611. doi: 10.1097/MD.0000000000018611.

Can Brain Changes Reflected by Alterations in Functional Connectivity be a Useful for Outcome Prediction in the Prodromal Stage?

Published on by Andrew Marshall1 Comment

Research Paper Title

Brain functional connectivity data enhance prediction of clinical outcome in youth at risk for psychosis.

Background

The first episode of psychosis is typically preceded by a prodromal phase with subthreshold symptoms and functional decline.

Improved outcome prediction in this stage is needed to allow targeted early intervention.

This study assesses a combined clinical and resting-state fMRI prediction model in 137 adolescents and young adults at Clinical High Risk (CHR) for psychosis from the Shanghai At Risk for Psychosis (SHARP) programme.

Methods

Based on outcome at one-year follow-up, participants were separated into three outcome categories including:

  • Good outcome (symptom remission, N = 71);
  • Intermediate outcome (ongoing CHR symptoms, N = 30); and
  • Poor outcome (conversion to psychosis or treatment-refractory, N = 36).

Validated clinical predictors from the psychosis-risk calculator were combined with measures of resting-state functional connectivity.

Results

Using multinomial logistic regression analysis and leave-one-out cross-validation, a clinical-only prediction model did not achieve a significant level of outcome prediction (F1 = 0.32, p = .154).

An imaging-only model yielded a significant prediction model (F1 = 0.41, p = .016), but a combined model including both clinical and connectivity measures showed the best performance (F1 = 0.46, p < .001).

Influential predictors in this model included functional decline, verbal learning performance, a family history of psychosis, default-mode and frontoparietal within-network connectivity, and between-network connectivity among language, salience, dorsal attention, sensorimotor, and cerebellar networks.

Conclusions

These findings suggest that brain changes reflected by alterations in functional connectivity may be useful for outcome prediction in the prodromal stage.

Reference

Collin, G., Nieto-Castanon, A., Shenton, M.E., Pasternak, O., Kelly, S., Keshavan, M.S., Seidman, L.J., McCarley, R.W., Niznikiewicz, M.A., Li, H., Zhang, T., Tang, Y., Stone, W.S., Wang, J. & Whitfield-Gabrieli, S. (2019) Brain functional connectivity data enhance prediction of clinical outcome in youth at risk for psychosis. NeuroImage Clinical. doi: 10.1016/j.nicl.2019.102108. [Epub ahead of print].

Teachers’ Perceptions of their Learners’ Mental Health Problems

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Research Paper Title

A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa.

Background

The combination of extensive poverty, violence and HIV has potential mental health impacts on children in Southern Africa.

This article is nested in a broader study to evaluate the strength and difficulties questionnaire (SDQ) among Sotho speakers, and assess the mental health status of children made orphans by AIDS.

The aim of this study was to describe the mental health problems that the teachers perceive among learners in their classrooms, to understand what the teachers saw as causing these problems and to identify potential approaches to address these problems within the school setting.

Methods

As part of the larger study, 10 teachers were purposively selected to write a report describing the mental health problems among learners in their class.

These findings were discussed at two later meetings with a larger grouping of teachers to validate the findings and obtain additional input.

Results

The teachers were concerned about the emotional state of their pupils, especially in relation to depression, anxiety, substance abuse, scholastic problems and aggression.

These problems were felt to arise from the children’s lived context; factors such as poverty, death of parents and caregivers from AIDS and trauma, parental substance abuse and child abuse.

The teachers expressed a desire to assist the affected learners, but complained that they did not get support from the state services.

Conclusions

Many learners were evaluated by teachers as struggling with mental health issues, arising from their social context.

The teachers felt that with support, schools could provide assistance to these learners.

Reference

Skinner, D., Sharp, C., Marais, L., Serekoane, M. & Lenka, M. (2019) A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa. Curationis. 42(1), pp.e1-e7. doi: 10.4102/curationis.v42i1.1903.