Common Mental Health Conditions Research Articles

The violence of narrative: embodying responsibility for poverty-related stress.

Narratives of self‐responsibility are pervasive in neoliberally oriented contexts, and have been found to engender feelings of shame and failure amongst those affected by poverty. Here, we use findings from research in two low‐income communities in south‐west England to examine how these narratives become embodied within people's daily lives when they intersect with systems of welfare support and the current political drive to upscale treatment for common mental health conditions. Drawing on Bourdieu's notion of symbolic violence, we examine how narratives of self‐responsibility and associated welfare reform strategies impact on the mental health of people living in economic hardship. The data show how such narratives inflict, sustain and exacerbate mental distress and suffering, and how they become naturalised and normalised by individuals themselves. We demonstrate how this situation pushes people to seek support from General Practitioners, and how clinical interactions can normalise, and in turn, medicalise, poverty‐related distress. Whilst some people actively resist dominant narratives around self‐responsibility, we argue that this is insufficient under broader sociocultural and political circumstances, to free themselves from the harms perpetuated by symbolic violence.

Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review

BackgroundDysmenorrhea is one of the most common menstrual disorders and is influenced by various factors. Psychological disorders including anxiety, depression, and stress have been suggested as influencing dysmenorrhea, but previous findings are inconsistent. This study will investigate the relationship between depression/anxiety/stress and dysmenorrhea using a systematic review and meta-analysis.MethodsOnline databases including PsycINFO, Scopus, PubMed, Science Direct, ProQuest, ISI Web of Knowledge, and Embase will be searched. Appropriate keywords and MeSH terms will be used to retrieve the journal papers published from 1990 until the end of December 2019. To improve search coverage, the reference lists of all included studies will be reviewed to find eligible papers. Inclusion criteria include the following: descriptive, cohort, case-control, and cross-sectional studies; the relationship between depression/anxiety/stress and dysmenorrhea being an objective of the study; and published in peer-reviewed journals. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of selected studies. A quantitative synthesis will be performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) via the STATA software, if retrieving enough number of studies with no severe methodological heterogeneities. Otherwise, qualitative synthesis will be used to report the findings.DiscussionTo the best of our knowledge, this will be the first systematic review on this topic. Performing an inclusive search in major databases over a wide timescale is one key strength of the proposed study and will maximize the coverage of the original research studies on this topic. Results of present study are expected to lead to deeper understanding the relationship between common mental health conditions and dysmenorrhea.Systematic review registrationPROSPERO CRD42018102199

Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study.

Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.

DOES PRENATAL WIC PARTICIPATION IMPROVE CHILD OUTCOMES?

A large body of literature documents positive effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes, and separately connects health at birth and future outcomes. But little research investigates the link between prenatal WIC participation and childhood outcomes. We explore this question using a unique data set from South Carolina that links administrative birth, Medicaid, and education records. We find that relative to their siblings, prenatal WIC participants have a lower incidence of ADHD (attention-deficit/hyperactivity disorder) and other common childhood mental health conditions and a lower incidence of grade repetition. These findings demonstrate that a "WIC start" results in persistent improvements in child outcomes across a range of domains.

Extent Of Depression Among Patients With Gastrointestinal TractSymptoms In Outpatient Clinic Of Al-Hussein Teaching Hospital In Al-NasiriyahAt 2018

Background:Depression is one of the most common mental health conditions inthe general population as well as in clinical practice. In clinical studies, there is astrong relationship between gastrointestinal symptoms and depression and thegastrointestinal symptoms remain for longer time and are more serious than inpatients without depression.Objective:To estimate extent of depression in gastrointestinal tract symptoms inmedical outpatient clinic attendees.Methods:The study was a cross-sectional analytical study for 154 adult populationin the Al-Hussein teaching hospital in Nasiriyah city,conducted at first March 2018and completed at end of September 2018. Tools of method was questioner and fordiagnosis of depression was used Diagnostic and Statistical Manual of Mental Disorders,fourth edition (DSM- IV) criteria. refusal rate was zero and for statisticanalysis was used SPSS version 22.Result:The study showed that 43.5 % of subjects with gastrointestinal symptomssuffer from depression. depression found in 40.7% of females and 47.1% of males. 50.0% of depressed patients were in two age groups of 20 -44 years and ≥ 65 years.Most of depressed patients were suffering constipation (51.3%), change in appetite (51.3%) and change in weight(50.7%), where only change in appetite hadsignificant association with depression, were p-value=0.001. More of depressedsubjects had GI symptoms with one month duration and ≥7 numbers of GIT symptoms.Recommendation:Raising awareness of general population about the depressionand relation of that with GIT symptoms.

Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions, StephenGrcevich, Zondervan, 2018 (ISBN 978‐0‐310‐53481‐5), 208 pp., pb $17.99

Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions, StephenGrcevich, Zondervan, 2018 (ISBN 978‐0‐310‐53481‐5), 208 pp., pb $17.99

Using Practice Facilitation to Improve Depression Management in Rural Pediatric Primary Care Practices.

Depression is a common and serious mental health condition frequently encountered in pediatric primary care. Pediatricians report discomfort in managing depression due in part to limited training and limited access to mental health care, which is accentuated in rural areas. We developed an evidence-based, quality improvement project designed to help pediatricians increase screening and initial management of depression in the primary care setting. We recruited practices from a pediatric accountable care organization as part of a larger quality improvement portfolio that used a practice facilitation model to support practices with data collection and project management. Practitioners received training on quality improvement, depression screening, and a depression management plan (referred to as the depression management bundle). Practices completed Plan-Do-Study-Act cycles to improve their performance. We recruited 4 practices in rural Ohio to participate. Screening increased from 0% to 81% within 6 months. All 4 practices measured documentation of the depression management bundle for patients diagnosed with depression. Composite data from these practices showed an increase in documentation from 59% to 86% by month 6. This study provides preliminary support for the use of practice facilitation combined with skills training to increase screening and improve documentation of depression management in rural primary care practices, where specialty mental health resources may be limited. Further research is needed to determine if this approach can be successfully disseminated and if patient outcomes improved.

Relatives of Enforced Disappeared Persons in Mexico: Identifying Mental Health and Psychosocial Support Needs and Exploring Barriers to Care

In the current study, we explored the needs for psychosocial support as well as barriers to care among relatives of enforced disappeared persons in Mexico. Interviews were conducted with 29 relatives of disappeared persons as well as with representatives from seven organisations working with relatives. Needs and barriers to care mentioned by the interviewees were categorised and rated according to the frequency of mentioning. The interviewers, a psychiatrist and a medical doctor, assessed emotional distress. All interviewed relatives reported and showed signs of severe emotional distress. Frequently reported mental health symptoms included suicidal thinking, sleeplessness, anxiety, changes in appetite, intrusive memories, irritability and major role impairments. The most frequently expressed needs for psychosocial support included peer support, support when in contact with law enforcement officers, treatment of mental health conditions, religious support and family support. The most frequently encountered barriers included having a negative opinion about the quality of available services, feelings of judgement from other people (e.g., due to incrimination), lack of available services and not knowing where to get help. These findings emphasise the need to provide practical and informational support to relatives of disappeared persons as well as to provide emotional support during the entire search process for their missing relative, and beyond. Key implications for practice There is an urgent need to provide practical and informational support to relatives of disappeared persons as well as to provide emotional and family support during the entire process of searching for the missing relative, including during contact with the law, searching, reconnection, and/or before, during and after exhumations and handing over of the remains. Psychosocial support providers should focus on living with uncertainty and refrain from pressure for closure as well as from imposing hope as a moral imperative. Mental health care professionals need to provide adequate treatment for common mental health conditions, including depression and posttraumatic stress disorder, within a supportive context.

Strategies to tackle by primary care physicians to mental health issues in India in COVID-19 pandemic.

Dear editor, Today India is facing the highest-burden and consequences to the Covid-19 pandemic. Everyone has been impacted and in stress related to economic issues, health issues, family issues, and social issues, etc., This kind of stress may further lead to mental health issues. COVID, lockdown, quarantine consequent increasing mental health burden worldwide. Policymakers should rethink for primary health care and primary health care warriors fighting with limited resources at the rural setup in India. There are observed very limited mental health facilities available in rural India. A study published by Jitendra Rohilla et al. highlighted a very important issue of primary care physicians approach for the mental health impact of COVID -19. He focused on the importance of the role of telemedicine as a supportive tool in this crisis.[1] He concluded that knowledge of common mental health conditions and psychotropics and liaison with mental health specialist through telemedicine could be a suitable approach for family physicians treating patients suffering from both psychological and medical disorders.[1] Herewith we would like to add the following strategies that could be helpful to tackle primary care Physicians to mental health issues in India in COVID-19 pandemic and making it more simplified, realistic, usable, etc. Utilization of regular mobile applications by primary care physicians like WhatsApp, WhatsApp calling, Zoom, Google Meet, etc., These may lead to direct increasing person to person communications, sharing of diagnostic reports, medication reports, etc. Arrangement of webinars (short duration) for primary care physicians on dedicated mental health issues, current scenarios, counseling management by state authorities, regional centers, tertiary care centers, Rotary clubs, medical Institutions, by local IMA forums, etc. Releasing counseling seminars, discussion forum program on local Radio, FM channels. Connect the physicians in groups and making regional networking with ICT (Information and communication technology) enabled tools. Circulation of PDF files, videos, multimedia content or e-content with the latest information related to mental health. Preparation of mental health hotline by government agencies. Developing specialized mobile applications dedicated to a mental health issue with the private partnership by government authorities. Arrangement of yoga sessions, laughter club sessions at COVID centers with proper measurements. Though in real government or policymakers has very little attention over this issue. These few simple measures can receive extensive important support in the current situation to the primary health care system and dedicated warriors. Their motivation, support care, improving knowledge will surely help in reducing mental health-related burdens. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Life Tasks and Psychological Muscle

In the formation of his theory, Adler argued that all the problems of life were related to communal life, work, and love. These three ideas are collectively referred to as the life tasks and are foundational elements in Individual Psychology. In this article, the three life tasks are discussed relative to the personal qualities necessary for successful satisfaction of each task. These qualities, which include responsibility, cooperation, and respect, are combined with courage in the face of imperfections to define psychological muscle. This concept is discussed relative to vulnerability and relative resistance to common mental health conditions.

Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada.

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.

Stress and Depressive Symptoms Among Demographically Diverse American Pregnant Women

Pregnancy is a sensitive period of life where mental health is of utmost importance to the mother’s and child’s well-being peripartum and beyond. To better prevent and treat common mental health conditions such as depressive symptoms and perceived stress (defined in this study to encompass psychological and physiological (heart rate variability (HRV)) dimensions), it is crucial to examine and report differences in mental health outcomes among demographically diverse pregnant women. Therefore, the purpose of this secondary analysis (N = 79) was to determine if there are differences in mental health outcomes between pregnant women who differ across demographic factors, as well as to determine if demographic factors predict mental health outcomes when controlling for other demographic variables. Findings indicate that there were significant differences in depressive symptoms and perceived stress by all demographic factors except age. Marital status and total household income were the only significant predictors of depressive symptoms and perceived stress, respectively, when all other factors were controlled. There were no significant differences or correlations between demographic variables and HRV. Pregnant women may be predisposed to adverse mental health outcomes, illustrating the need for more refined interventions that are sensitive to pre-existing factors.

The Influence of Non-Clinical Patient Factors on Clinical Decision Making: Uncovering the Impact on Mental Health

BackgroundUnderstanding how non-clinical patient factors (NCpF) such as gender, educational level and socioeconomic status impact clinical decisions regarding one’s mental health is important for appropriate and equitable care.
 Main AimThis research aims to i) investigate the feasibility of using administrative health data to investigate clinical decision making in mental health; ii) understand the impact of NCpF on mental health-related diagnosis, treatment, and referral decisions.
 Methods/ApproachThree waves of the Welsh Health Survey, containing a five-item Mental Health Inventory (Short- Form SF36), and NCpF information were used to create our interest cohort.
 The records with a low SF36, a ‘gold standard’ identifier of common mental health conditions, were then linked to the healthcare records datasets (Primary Care GP Dataset, Patient Episode Database for Wales, Emergency Department Dataset, Outpatient Referral Dataset, Annual District Death Extract) securely stored on the Secure Anonymised Information Linkage Databank.
 ResultsWe will present the methodological challenges and benefits of using administrative data the study of decision making in mental health.
 The differences in NCpF between those with a low SF36 and a mental health diagnosis, symptoms and treatment as well as those with a similar SF36 score but no diagnosis, symptoms or treatment recorded will be presented and discussed.
 ConclusionAdministrative data can provide a unique opportunity to investigate issues related with clinical decision-making in mental health and improve health equity. Having a better understanding of the influence of NCpF on mental health decisions is necessary to prevent inequity in mental health care.

Diagnosis and Management of Eating Disorders in Pregnancy

Background: To provide a review of the literature with regards to the diagnosis and management of eating disorders in pregnancy. Methods: Available literature was reviewed and summarized to discuss the epidemiology, diagnosis, natural history of the illness, and treatment. Results: Eating disorders are common mental health conditions in reproductive-aged women, including pregnant women. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most commonly diagnosed, with a mixed clinical picture existing due to the fluidity between these conditions. Pregnancy can often act as a trigger for eating disorders given the focus on weight gain and the stressors associated with the changing physical appearance of pregnancy. There are significant maternal and fetal risks associated with eating disorders in pregnancy including an elevated risk of cesarean delivery, postpartum depression, preterm delivery, and perinatal mortality. Treatment of eating disorders should involve a multidisciplinary team of providers with close monitoring in pregnancy and the postpartum period with honest discussions on handling weight gain and triggering restrictions associated with pregnancy. Conclusion: Pregnancy is a high-risk time for women with eating disorders given the significant maternal and fetal risks of their illness.

Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment.

Telepsychology holds promise as a treatment delivery method that may increase access to services as well as reduce barriers to treatment accessibility. The aim of this rapid evidence assessment was to assess the evidence for synchronous telepsychology interventions for 4 common mental health conditions (depression, anxiety, posttraumatic stress disorder, and adjustment disorder). Randomized controlled trials published between 2005 and 2016 that investigated synchronous telepsychology (i.e., telephone delivered, video teleconference delivered, or Internet delivered text based) were identified through literature searches. From an initial yield of 2,266 studies, 24 were included in the review. Ten studies investigated the effectiveness of telephone-delivered interventions, 11 investigated the effectiveness of video teleconference (VTC) interventions, 2 investigated Internet-delivered text-based interventions, and 2 were reviews of multiple telepsychology modalities. There was sufficient evidence to support VTC and telephone-delivered interventions for mental health conditions. The evidence for synchronous Internet-delivered text-based interventions was ranked as "unknown." Telephone-delivered and VTC-delivered psychological interventions provide a mode of treatment delivery that can potentially overcome barriers and increase access to psychological interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey.

BackgroundDepression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online.ObjectiveThe objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties.MethodsThe study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation.ResultsIn study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety.ConclusionsPeople with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web.International Registered Report Identifier (IRRID)RR2-10.1007/978-3-319-21006-3_3

Mental Health Diagnoses in Veterans Referred for Outpatient Geriatric Psychiatric Care at a Veterans Affairs Medical Center.

Nearly half of the U.S. veterans are over 65years of age. Older veterans are at higher risk for mental health (MH) conditions, which are associated with increased mortality and health care costs. Given the deficit of specialty-trained geriatric providers, we are conducting a Quality Improvement initiative to improve MH services for older veterans at Minneapolis Veterans Affairs Health Care System. Our first step is to understand the demographic and diagnostic characteristics of veterans referred for geriatric MH specialty treatment. We conducted a retrospective chart review of demographics and psychiatric diagnoses in veterans seen for outpatient geriatric MH intake between May 1, 2011 and April 30, 2016. We used chi-square and Spearman's rho tests to examine age, diagnoses, and service-time era variables. 1,059 veterans were evaluated, average age of 73.5years. Depressive (47%), neurocognitive (42%), and anxiety disorders (22%) were the most common MH conditions. Vietnam veterans showed higher prevalence of depressive (56%), post-traumatic stress (11%), and alcohol use (10%) disorders. World War II veterans showed higher prevalence of neurocognitive disorders (71%). Neurocognitive disorder prevalence was significantly correlated with age. Prevalence and comorbidity of major MH conditions is high in veterans referred for geriatric MH services. Future work will examine challenges faced by non-specialty providers in caring for older veterans, with the goal of developing targeted educational and clinical interventions to better address aging veterans' MH needs.

Implementation of an augmented stepped mental health care service in Australian primary care: a mixed method study

ABSTRACT Objective: StepCare is an online, stepped mental healthcare service in general practice which identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to the patient and GP. Previous data suggested that StepCare was acceptable and feasible, assisting GPs to identify and manage patients’ depression and anxiety. Areas for improvement were recommended by GPs, practice staff and patients. StepCare was accordingly upgraded and a new implementation strategy was introduced, consistent with the Australian Government's reform agenda. This study aimed to evaluate the augmented StepCare and new implementation model. Methods: Two Primary Health Networks (PHNs) and 22 general practices took part. The StepCare team trained and supported PHN staff to implement the Service in their general practices. PHN staff, GPs, practice staff and patients rated the acceptability, feasibility and effectiveness of StepCare. New cases at screening and patients’ symptom change over 12 weeks were measured. Implementation facilitators and barriers were also investigated. Results: The majority of PHN staff, GPs, practice staff and patients rated StepCare as acceptable and feasible, GPs reported it assisted their identification and management of common mental health conditions and most patients indicated they would recommend it to a friend. 37% of patients reporting symptoms at screening were new cases. Patients’ depression symptoms reduced significantly by 12 weeks. Discussion: Augmented StepCare is able to identify new cases and produce clinical change within routine general practice. It also has the potential to be implemented by PHNs with assistance from the StepCare team.

An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh

BackgroundTo assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh.MethodsWe recruited 2425 adult samples (18–90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs.ResultsOf 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58–1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67–0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26–0.61) and severe MHCs (β 0.25, 95% CI: 0.13–0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling.ConclusionsAwareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education.

1. IMPLEMENTATION AND EVALUATION OF A STRUCTURED EXPERIENCE IN MENTAL AND BEHAVIORAL HEALTH

Background Mental and behavioral health (MBH) is an underserved area in pediatrics. Increasingly, pediatricians are called upon to be first line providers for children with MBH needs, and the ABP has charged residency programs with meeting this need by bolstering educational initiatives in MBH. Objective Create an MBH rotation to improve residents' ability to evaluate and treat ADHD, anxiety, and depression. Methods A 2-week rotation in MBH was added to the PL-1 year, with experiences on an inpatient psychiatric consult service, in community psychiatry clinics, in subspecialty clinics with psychologists, and in continuity clinic with a behavioral health coordinator. Supplemental readings and online modules in psychopharmacology, depression, anxiety and ADHD were available for self-study. PL-1s were surveyed at the start of residency to determine baseline knowledge and confidence in MBH, and they completed the same survey after the rotation. PL-3 residents who did not participate in the rotation were also surveyed. Survey responses were compared by t-test. Results After the rotation, a significantly higher proportion of PL-1s answered questions regarding evaluation and treatment of ADHD, anxiety, and depression correctly compared to before the rotation; self-reported facility with management of these conditions also significantly increased (Fig. 1A). PL-1s' post-rotation knowledge of ADHD management was equal to that of PL-3s', and PL-1s' knowledge of anxiety and depression management was significantly higher than PL-3s'. Similarly, self-reported ability to manage ADHD was equivalent between the 2 groups and statistically higher for PL-1s with respect to anxiety and depression (Fig. 1B). Conclusions Our PL-1s' ability to manage common pediatric mental health conditions was increased by participation in a structured MBH rotation. These gains were equivalent or superior to knowledge acquired longitudinally by senior residents through incidental clinical experiences, suggesting that structured experiences in mental and behavioral health may be more effective.