History Of Mental Health Issues Research Articles

Understanding Postpartum Depression: A Comprehensive Review

Postpartum depression (PPD) is a significant mental health concern affecting women worldwide, with implications for maternal well-being and infant development. This article provides a comprehensive overview of PPD, including its prevalence, risk factors, and impact on maternal-infant health outcomes. The prevalence of PPD varies across different countries, with recent studies indicating rates ranging from 10% to 23% among new mothers. Younger maternal age, history of mental health issues, lack of social support, and stressful life events are among the identified risk factors for developing PPD. Untreated PPD can have detrimental effects on both maternal and infant health. Mothers experiencing PPD may struggle with bonding with their infants, leading to disrupted attachment and compromised emotional regulation in infants. Furthermore, untreated PPD is associated with adverse outcomes such as impaired cognitive development in infants and an increased risk of behavioral and emotional difficulties in children. Early detection and intervention are crucial in addressing PPD and mitigating its impact. Healthcare providers play a vital role in recognizing PPD symptoms and providing appropriate support and treatment options to affected mothers. Screening programs aimed at identifying at-risk women during prenatal and postnatal care can help in timely intervention and support. In conclusion, understanding the prevalence, risk factors, and consequences of PPD is essential for promoting maternal mental health and ensuring optimal outcomes for both mothers and infants. Efforts to increase awareness, improve screening practices, and enhance support services are critical in addressing this significant public health issue.

Evaluation of the internet-based intervention “Selfapy” in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study

PurposeDepressive disorders cause a major burden of disease worldwide and often lead to a loss of social functioning. Patients suffering from depressive disorders report a lower quality of life (QOL) than people without a history of mental health issues. Internet-based interventions (IBIs) based on cognitive behavioral therapy (CBT) are effective in reducing symptom severity but data on their impact on quality of life in clinically depressed patients so far is scarce.MethodsSelfapy is a CBT-based IBI for depressive disorders. 401 participants (332 female, mean age 37 (SD = 11) with a diagnosis of major depressive disorder (MDD) or dysthymia were enrolled in a randomized, parallel, three-arm trial comparing a therapist-guided Selfapy intervention with an unguided Selfapy intervention and a waiting list control. QOL was measured using the WHOQOL-BREF at baseline, post-treatment (12 weeks) and at 24-week follow-up. The effects of the interventions on QOL were calculated using linear mixed effects models.ResultsAt post-treatment (12 weeks) the guided and unguided intervention groups reported an increase in QOL on physical and psychological health domains compared to controls (significant group*time interaction). The gain in QOL was maintained over the follow-up period only for psychological health. QOL decreased in the social relationships and environment domains over the course of treatment and during the follow-up treatment for all participants. There were no differences between the guided and the unguided intervention.ConclusionSelfapy proved to positively affect psychological and physical QOL in a sample of participants suffering from depressive disorders and can therefore be considered an effective and highly scalable therapeutic tool. The pattern of results might partly be attributable to effects of the COVID-19 pandemic and public health measures that coincided with the trial.Trial registration: German Clinical Trials Register (DRKS): DRKS00017191. Registered June 14th, 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017191.

Effects of the COVID-19 Pandemic on University Students' Mental Health: A Literature Review.

This review aims to focus on the effects of COVID-19 on university students' mental health and deepen our understanding of it. The conclusions are based on the review of 32 studies conducted during the pandemic. This review confirms that university students were at high risk for mental health disorders, heightened stress, and increased sleep comorbidities both pre-pandemic and during the pandemic. This literature review confirmed a few universal trends, i.e., increased stress, anxiety, and depression, during the pandemic. The rates of insomnia, obsessive-compulsive disorder, and suicidal ideation also went up. Overall, female students are at a disadvantage in the development of mental health issues. Male students coped better but may be at higher risk for lethality in suicidal ideation. Students with a history of mental health issues and other comorbidities prior to the pandemic had worse outcomes compared to healthy individuals. The study points to a strong positive correlation between fear and increased rates of stress, anxiety, and insomnia. There is also a positive correlation between declining mental health and online learning. A strong negative correlation was present between physical activity and depressive symptoms. These findings are universal across many countries and regions where the studies occurred.

Assessment of Symptoms of Depression, Anxiety & Stress among Medical Students

Aims: To Assess Depressive, Anxiety & Stress related symptoms and their correlation with sociodemographic factors amongst recently enrolled medical students.
 Study Design: Cross sectional study.
 Place and Duration of Study: Recently enrolled 275 Medical students attending University between June 2022 and September 2022.
 Methodology: Study conducted among recently enrolled 275 Medical students. After taking their prior informed consent through online form shared through WhatsApp group, they were given to fill online questionnaire to collect sociodemographic factors in English made using PsyToolkit software. It also contains Depression Anxiety Stress Scale (DASS 21), which was used to collect information on depressive, anxiety, and stress related symptoms.
 Results: Prevalence of depressive symptoms is 68.4%, anxiety symptoms are 78.2% and stress related symptomsis 33.1% among medical students. Depressive, anxiety and stress related symptoms were statistically significantly associated with peer and family pressure to join study-stream (p-value of <.01 for all three) and history of mental health issues in family (p-value=.01 for all three). In addition, depressive symptoms were statistically significantly associated with poor peer-relationship (p-value=.01) and unsatisfaction regarding admission (p-value=.04); and stress related symptoms was statistically significantly associated with unsatisfaction regarding admission (p-value=.03).
 Conclusion: Prevalence of depressive, anxiety & stress related symptoms among recently enrolled medical students are high providing insight into needed improvement of psychological wellbeing in them; which could potentially have a positive impact upon their quality of life & patient care.

Social and demographic characteristics of child maltreatment fatalities among children ages 5–17 years

BackgroundWhile risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children. ObjectivesTo describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides. Participants and settingSecondary analysis of deaths due to child abuse or neglect among children ages 5–17 years old occurring during 2009–2018 and documented in the National Fatality Review-Case Reporting System. MethodsChild, family, and social characteristics were compared by child age (5–10 years vs. 11–17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics. Results1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5–10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides. ConclusionsThe causes of child maltreatment deaths among children 5–17y vary by age. Child neglect caused and/or contributed to most child suicides.

The mental health impact of COVID-19 on pre-registration nursing students in Australia: Findings from a national cross-sectional study.

The study aimed to measure and describe the mental health impact of COVID-19 on Australian pre-registration nursing students. The COVID -19 pandemic has had a swift and significant impact on nursing students across the globe. The pandemic was the catalyst for the closure of schools and universities across many countries. This necessary measure caused additional stressors for many students, including nursing students, leading to uncertainty and anxiety. There is limited evidence available to identify the mental health impact of COVID-19 on Australian pre-registration nursing students currently. A cross-sectional study was conducted across 12 Australian universities. Using an anonymous, online survey students provided demographic data and self-reported their stress, anxiety, resilience, coping strategies, mental health and exposure to COVID-19. Students' stress, anxiety, resilience, coping strategies and mental health were assessed using the Impact of Event Scale-Revised, the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Brief Cope and the DASS-21. Descriptive and regression analyses were conducted to investigate whether stress, anxiety, resilience and coping strategies explained variance in mental health impact. Ethical Approval was obtained from the University of New England Human Research Ethics Committee (No: HE20-188). All participating universities obtained reciprocal approval. Of the 516 students who completed the survey over half (n=300, 58.1%) reported mental health concerns and most students (n=469, 90.9%) reported being impacted by COVID-19. Close to half of students (n=255, 49.4%) reported signs of post-traumatic stress disorder. Mental health impact was influenced by students' year level and history of mental health issues, where a history of mental health and a higher year level were both associated with greater mental health impacts. Students experienced considerable disruption to their learning due to COVID-19 restrictions which exacerbated students' distress and anxiety. Students coped with COVID-19 through focusing on their problems and using strategies to regulate their emotions and adapt to stressors. The COVID-19 pandemic has considerably impacted pre-registration nursing students' mental health. Strategies to support nursing students manage their mental health are vital to assist them through the ongoing pandemic and safeguard the recruitment and retention of the future nursing workforce. This study adds an Australian understanding to the international evidence that indicates student nurses experienced a range of negative psychosocial outcomes during COVID-19. In this study, we found that students with a pre-existing mental health issue and final-year students were most affected. The changes to education in Australian universities related to COVID-19 has caused distress for many nursing students. Australian nursing academics/educators and health service staff need to take heed of these results as these students prepare for entry into the nursing workforce. The study was designed to explore the impact of COVID-19 on the mental health of undergraduate nursing students in Australia. Educators from several universities were involved in the design and conduct of the study. However, the study did not include input from the public or the intended participants.

A multisample demonstration of using the prolific platform for repeated assessment and psychometric substance use research.

The Prolific platform offers a potentially useful and efficient crowdsourcing option for repeated assessment substance use research, including for psychometric research requiring large samples. We present both (a) a series of practical recommendations for using Prolific and (b) data from multiple samples demonstrating Prolific's potential for efficiently collected repeated measures data. First, we present data from a 5-day daily diary protocol. We recruited a large sample (N = 321 at Day 1) screened for a history of self-identified mental health issues and weekly alcohol use. Participant adherence was good (82%) even without in-person contact. Alcohol use patterns conformed to theoretical expectations: Participants were more likely to drink on Fridays and Saturdays than other days, men drank more than women, and higher Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) scores were associated with an increased likelihood of use and more overall drinking on a given day. Second, we present data from 429 Prolific participants screened for a history of mental health issues who completed assessments 2 weeks apart with strong retention (N = 377; 88%). We compare these data with the data from undergraduates (N = 529) to demonstrate Prolific's utility for conducting psychometrically oriented substance use research. Internal consistency estimates for measures from the Prolific data matched or exceeded those from the undergraduate data. Furthermore, measure scores showed strong temporal stability, and factor structures (e.g., AUDIT item-level structures) conformed to theoretical expectations. Collectively, these findings indicate that Prolific can be used successfully for repeated measures data collection. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Poster 210: Effects of a Comprehensive Behavioral Health Program on Functional Outcomes after Osteochondral Allograft Transplantation in the Knee

Objectives:To use prospectively collected registry data to evaluate an evidence-based shift in practice for implementation of a comprehensive behavioral health program, including preoperative screening and education in conjunction with postoperative counseling for their effects on patient-reported mental health scores and functional outcomes after osteochondral allograft (OCA) transplantation in the knee. We hypothesized that patient-reported preoperative mental health issues would be associated with inferior outcomes and that the comprehensive behavioral health program led by a health behavior psychologist would be associated with superior outcomes for these patients.Methods:With IRB approval and informed consent, patients undergoing transplantation in the knee were enrolled in a lifelong registry designed to collect comprehensive outcomes data. Patients that had large (>4cm2) shell-graft OCA transplants and complete one-year data for patient-reported IKDC subjective knee evaluation, VAS Pain, SANE, PROMIS Physical Function, and PROMIS Mental Health measures for pre-operative and 1-year time points were included in analyses. One-year improvement (D) scores for each variable were calculated as the difference between each score compared to the respective pre-operative score. Patients who required OCA revision surgery or total knee arthroplasty within the study period were defined as graft failures. Patients treated after the shift in practice were assigned to the Psych cohort. Patients who self-reported a history of mental health issues (Anxiety, Depression, Bipolar, ADHD, Schizophrenia) were assigned to the Mental Health Issue (MHI) cohort. Patients whose mental health history could not be obtained were not included in the respective analyses. Two-tailed t-Tests were used to analyze the survey scores between cohorts. Chi-square tests were used to compare proportions of successful versus failed outcomes between cohorts. A p value < 0.05 was used to indicate statistical significance for all tests.Results:A total of 269 patients met criteria for inclusion in the Psych analysis and 189 patients met criteria for inclusion in the MHI analysis. One-year SANE raw scores (p=0.03), one-year Physical Function D scores (p<0.0001), one-year IKDC D scores (p<0.0001), and one-year Pain D scores (p=0.01) were significantly better for patients in the comprehensive behavioral health program cohort. One-year PROMIS Mental Health D scores (p<0.0001), one-year Physical Function raw scores (p=0.03), and one-year Physical Function D scores (p<0.0001) were significantly better for patients who did not have a history of mental health issues, while one-year SANE D scores (p<0.0001) were significantly better in the MHI cohort. A significantly higher proportion of patients in the comprehensive behavioral health program cohort had successful 1-year outcomes (87.5 versus 64%, p=0.037). No statistically significant difference in proportions of successful versus failed grafts was noted between patient cohorts with self-reported preoperative mental health issues compared to those without self-reported preoperative mental health issues (p=0.23).Conclusions:The results of this study highlight the potential impacts of mental and behavioral health on outcomes after osteochondral allograft transplantation surgeries in the knee. Improvements in pain, knee function, and overall physical function were significantly better in patients enrolled in a comprehensive behavioral health program prior to surgery, while patients with self-reported preoperative mental health issues including anxiety, depression, bipolar disorder, ADHD, or schizophrenia had significantly worse outcomes with respect to mental health, physical function, and knee function. In addition, graft failure rate as defined by the need for OCA revision or TKA was significantly lower (12.5%) for patients undergoing comprehensive preoperative behavioral health screening and education. Taken together, these data suggest that mental and behavioral health can have significant influences on clinical outcomes after OCA transplantation in the knee and that preoperative assessment and education in conjunction with postoperative counseling and support may result in more successful outcomes for patients. However, based on the multifactorial nature of outcomes in these complex cases, longer term outcome studies in a larger population of patients are required before conclusions regarding the direct impact of this shift in practice can be made.

A survey of Post-Traumatic Stress Disorder, Anxiety and Depression among Flood Affected Populations in Kerala, India.

BackgroundGlobally, post traumatic stress disorder (PTSD) is one of the most common psychiatric illnesses following a disaster. We aimed to evaluate the relationship between the socio-economic and flood exposure factors with PTSD, depression and anxiety among the flood-affected populations in Kerala, India.MethodsA cross-sectional household survey was conducted from November 2019 to January 2020 in Kozhikode district of Kerala, India. Adults (≥ 18 years), who were permanent residents and had been directly exposed to the flood, were invited to take part in the study. Individuals with a history of mental health issues and those who had other stressful situations in the past were excluded. The survey questionnaire was based on three screening tools: (1) PTSD Checklist for DSM-5 (PCL-5); (2) patient health questionnaire (PHQ-9); and (3) generalized anxiety disorder (GAD-7). Data included sociodemographic factors and flood exposure variables. The primary outcome variable was psychiatric morbidity (PTSD, anxiety and depression).ResultsA total of 276 respondents (150 males/126 females) participated in the study. A significant correlation was observed between total score on PCL-5 and GAD-7 (r=0.339, p=0.001) and PHQ-9 (r=0.262, p=0.001). Females had significantly higher total PTSD symptom severity scores (8.24±5.88 vs. 6.07±5.22; p=0.001), severity of symptoms of intrusion (4.66±3.60 vs. 3.69±3.20; p=0.04), increased level of anxiety (2.54±1.94 vs. 1.79±1.53; p=0.001) and depression (3.02±2.26 vs. 2.04±1.67; p=0.001) compared to males. However, the gender difference for PTSD symptoms disappeared when controlling for age.ConclusionThe findings of this survey revealed that the vast majority of respondents (92 percent females and 87 percent males) still had subclinical psychiatric symptoms one year after the flood. Therefore, tailored psychological interventions are warranted to counter the long-lasting impact of flooding on the mental health of individuals.

P176 Meeting the demands of employment: the impact and rehabilitation of chronic pain and fatigue in the UK armed forces

Background/AimsThe growing prevalence of chronic pain and the recent influx of post-viral fatigue (due to COVID-19) will limit the working output of the UK population. As such presentations become more common, the ability of the working population to meet the demands of their employment will depend on the effective management of chronic pain and fatigue.We investigated the working ability and outcomes of UK military personnel two years after rehabilitation for persistent pain or fatigue.MethodsWe collected the health data of 35 personnel presenting with primary persistent pain, fibromyalgia, or persistent fatigue during admission to the 2-week Specialist Rehabilitation Course at DMRC between November 2018 to December 2019. Participants scored their current ability to work and the work-related impact of their symptoms by completing a follow-up survey. This group also evaluated the efficacy of 14 evidence-based rehabilitation tools provided during their rehabilitation programme based on how they improved their ability to work.Results88.2% of attendees had a history of mental health issues, whilst 82.4% had other medical comorbidities. Royal Air Force (RAF) personnel predominantly presented with fatigue rather than pain; this subgroup left the armed forces two years earlier than the service average. 62.9% of attendees responded to our survey. 63.6% of respondents no longer served in the military two years after their initial admission to the rehabilitation course. All current military personnel reported either “good” or “very good” symptom management and as a cohort reported better work outcomes than those who had left the military. Respondents reported mindfulness, activity pacing and education about symptoms as the most effective strategies for improving work capability. Those who found these strategies most useful had the best outcomes. 7 of the 8 retained military personnel found at least two of these strategies useful for improving their work ability compared to 4 of the 14 military leavers.ConclusionPoor working ability due to persistent pain or fatigue was not compatible with sustained military employment. Yet, the tools provided at DMRC improved the ability to work for those remaining in the military. Military personnel with persistent pain and fatigue benefitted most from mindfulness, activity pacing and education. Response to these specific strategies corresponded with both continued military service and better work capabilities. These findings are consistent with the recent literature regarding the efficacy of these rehabilitation strategies for persistent pain and fatigue. The occupational outcomes of military personnel in this study may be comparable to that of civilian populations; specifically sectors with similar demands or mental health risks as the armed forces.Disclosure E. Chisala: None. S. Bahadur: None.

Assessing the knowledge, perceptions, and mental health impact of COVID-19 among students in Rwanda

PurposeThis paper aims to assess the knowledge, perceptions and mental health impact of COVID-19 among students in Rwanda.Design/methodology/approachThis paper is a cross-sectional online survey questionnaire.FindingsThe mean knowledge score among the 375 respondents was 75.14% (SD ± 19.1), with 195 (55.1%) of the respondents scoring below 80%. Students who believed that COVID-19 education was sufficient were more likely to have lower knowledge levels (OR = 1.84, 95% CI = 1.15; 2.94). While most respondents were aware of their vulnerability to the virus, they did not see themselves at risk of becoming infected. The percentage of respondents reported to have some form of mental health issues was 49.7%. The three most important factors in influencing mental health were age, history of mental health issues, and the way news was reported. Education quality was less affected for those who received online schooling (OR = 0.55, 95% CI = 0.33, 0.94).Practical implicationsEducation about COVID-19 should be strengthened by capitalizing on existing online and offline learning platforms to frequently update new or changing information.Originality/valueThis paper was the first study assessing the knowledge, perception and mental health impact of COVID-19 among Rwanda students.

Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment

ProblemWhile routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician. AimsTo assess the impact of psychosocial risk, current symptoms and mode of assessment on women’s honesty of disclosure at psychosocial assessment. MethodsLogistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were ‘always honest’ and ‘not always honest’. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk. Findings10.8% (N=193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR=1.78, 95%CI: 1.18–2.67, p<0.01) and lack of social and partner support (aOR=1.74, 95%CI: 1.16–2.62, p<0.05; aOR=2.08, 95%CI: 1.11–3.90, p<0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest. DiscussionA history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback. ConclusionGreater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.

Mental Health Literacy and Help-Seeking Behaviours Among Undergraduate Pharmacy Students in Abha, Saudi Arabia.

BackgroundThe serious mental health problems experienced by university students could have a negative impact on their long-term mental, social and physical health as well as their academic achievements. The ability to recognise a condition, and knowledge about mental health issues and sources of help, are among the factors influencing help-seeking behaviour in young individuals. This study was conducted to examine the mental health literacy among undergraduate pharmacy students and to assess whether mental health literacy is linked to a stronger intention to seek help.MethodsThis prospective cross-sectional study used an online self-administered questionnaire. A total of 271 pharmacy students at King Khalid University completed the questionnaire and agreed to participate in the study.ResultsThe mental health literacy in the current study (M=112.53) was found to be lower than that reported in international research using the MHLS. Students with no history of mental health issues scored significantly higher in help-seeking behaviours from informal sources (M=23.65, SD=6.88) than those with a previous history (M=19.03, SD=7.58), F (1, 269)=11.76, p=0.001. The study revealed a significant positive correlation between mental health literacy and help-seeking behaviours r(271)=0.26, p<0.01.ConclusionThis study demonstrates that there is a positive correlation between mental health literacy and help-seeking behaviours. Implementing appropriate interventions could be a key priority in improving the mental health literacy and help-seeking behaviour of students.

Psychological Distress during COVID-19 Lockdown among Dental Students and Practitioners in India: A Cross-Sectional Survey.

Objective In response to the coronavirus disease 2019 (COVID-19) pandemic, the Indian Government imposed a countrywide lockdown of 21 days from March 25 to April 14, 2020, which was further extended to 60 days. The sudden draconian measures changed the delivery of dental education and practice throughout the country. The study aimed to screen for depression during the COVID-19 lockdown and the factors associated with it among dental students and practitioners in highly COVID-19 infected states of India. Materials and Methods The current study is an online cross-sectional survey performed in Delhi NCR, Maharashtra, and Tamil Nadu during May 2020. The participants were recruited by convenience sampling. The main outcome measure was the screening of depression using the Patient Health Questionnaire (PHQ-9), which was categorized as mild, moderate, and severe depression. The data analysis was performed with IBM SPSS Version 23.0. A multivariable logistic regression model was fitted to identify the independent predictors of depression. Results In total, 335 dental students and practitioners participated in the survey. Among this, a significant number of the dental students (54%) and practitioners (44%) scored moderate to severe depression in terms of depression severity according to the PHQ-9 scores. Those who were screened depressed were likely to be males and younger than 30 years old. The results of correlation analysis indicated that worry about the professional growth, concerns regarding setbacks in clinical and research experiences, previous history of mental health issues, and fear of contracting COVID-19 from patients were positively related to higher depression scores in students. Moreover, for practitioners, fear of contracting COVID-19 from the patients scored higher levels of depression. The practitioners who reported less concern about their practice/job post COVID-19 lockdown and those who were able to meet their financial expenses during the lockdown were the least likely to be depressed. Conclusion The results of this study indicate a high level of depression among a significant number of dental students and practitioners. It is important to monitor and address the mental health needs of dental students and practitioners during and after the lockdown.

Adolescent suicide: what can pediatricians do?

Suicide is a major public health concern and the second leading cause of death for adolescents. Faced with an already-high prevalence and increasing rates over the past decade, pediatricians feel inadequately prepared to manage a suicidal patient. This article will review the changing rates of suicide, discuss recent literature on risk factors, identify methods to screen for suicidal thoughts and suggest an approach to counseling a suicidal patient. Finally, there will be a brief discussion on safety planning and public health measures to help reduce suicide rates. Rates of attempted suicide and death by suicide have been increasing for more than a decade. Risk assessment of potential suicidality remains very challenging, as the risk factors are multifactorial. However, some common risk factors persist including sexual minority identification and family or personal history of mental health issues. Although keeping these and other risk factors in mind, regular screening of adolescents for depression and self-harm is important. Finally, the best safety plans and treatment methods appear to be team-based. It remains the responsibility of pediatricians to stay aware of risk factors, regularly screen adolescents and prioritize collaborative safety planning for suicidal patients.

If You Didn’t Document It, It Didn’t Happen: Improving Documentation of Annual Visits at Resident Clinic [14F

INTRODUCTION: Improve documentation of annual exams based on ACOG’s Women’s Preventative Service Initiative. By increasing consistency in documentation, improve provided patient care. METHODS: Study broken into cycles: (1) A needs assessment (2) first intervention (3) post intervention analysis, (4) 2nd intervention, (5) 2nd post intervention analysis. Epic EMR between 10/2018-05/2019 used to review note documentation by examining presence/absence of the following key elements: gynecologic history section, age appropriate screening offered, HPV vaccination status, Flu vaccination status, menstrual flow, inter-menstrual bleed, healthy living tips, sexual partners, sexual dysfunction, STD testing, fertility desire, family history specific to gynecologic cancer, BMI, Smoker status, history of domestic violence, history of mental health issues. Descriptive analysis was performed using Pivot Table function in Microsoft. Chi square and Fisher exact tests were performed to look for statistical significance. RESULTS: One hundred and seven (n=107) notes were evaluated in needs assessment study, documentation scores varied between 1 to 15 out of 18 total. A new note template was introduced to EMR. 68 charts were analyzed and scores varied from 3-18 out of total score of 18. 2nd intervention was implemented with one-on-one feedback to providers. 21 charts were reviewed, scores varied 8-18, out of 18. Overall Median scores improved from 8 to 15 to 18 after each intervention. 15 components were noted to have a statistically significant improvement in documentation. CONCLUSION: Study findings support planned use of the Institute of Healthcare Improvement’s model of Plan-Do-Study-Act (PDSA) cycles to modify the EMR note template. These efforts enhance physician documentation of patient well-being.

The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases

Background:The impact of basal ganglia stroke on mental health is better described in adults than in children. We report 2 children with significant mental health issues after basal ganglia stroke.Case Reports:Patient 1, an 8-year-old boy, had mild anxiety before his left basal ganglia stroke. Post-stroke, he developed severe anxiety, obsessions, depression, and attention deficit hyperactivity disorder, in addition to a right hemiplegia and some mild chorea. He gradually improved over 3 years with psychiatric care and medication but continued to have residual symptoms. Patient 2, a 10-year-old boy, had no history of mental health issues before his right basal ganglia stroke. Post-stroke, he developed significant anxiety and mild depression, along with a left hemiplegia. He improved over 9 months and returned to his mental health baseline.Conclusions:Mental health issues after basal ganglia stroke in children can be significant, and recovery can take months to years.

Drivers of Increasing Emergency Ambulance Demand

Objectives: Although the factors driving emergency department demand have been extensively investigated, a comparatively minimal amount is known about the factors that are driving an increase in emergency ambulance demand. Methods: We conducted a retrospective observational study of consecutive cases attended by Ambulance Victoria in Melbourne, Australia from 2008 to 2015. Incidence rates were calculated, and adjusted time series regression analyses were performed to assess the driving factors of ambulance demand. Results: A total of 2,443,952 consecutive cases were included. Demand grew by 29.2% over the 8-year period. The age-specific incidence increased significantly over time for patients aged < 60 years, but not for patients aged ≥ 60 years. After adjustment for seasonality and population growth, demand increased by 1.4% per annum (incident rate ratio [IRR] = 1.014 [1.011–1.017]). The largest annual growth in demand was observed in patients with a history of mental health issues (IRR = 1.058 [1.054–1.062]), alcohol/drug abuse (IRR = 1.061 [1.056–1.066]), or a Charlson Comorbidity Index [CCI] score ≥ 4 (IRR = 1.045 [1.039–1.051]). Cases involving patients of relative socio-economic/educational disadvantage, younger age, or with no preexisting health conditions according to the CCI also grew faster than the overall patient population. Cases requiring transport to hospital increased by 1.2% annually (IRR = 1.012 [1.009–1.016]), although patients not requiring medical intervention from paramedics increased by 6.7% annually (IRR = 1.067 [1.063–1.072]). Conclusions: Increases in ambulance demand exceeded population growth. Emergency ambulances were increasingly utilized for transport of patients who did not require medical intervention from paramedics. Identifying the characteristics of patients driving ambulance demand will enable targeted demand management strategies.

Examining the Importance of Family History in Pediatric Behavioural Referrals.

In recent years, there has been a substantial increase in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Without appropriate management of symptoms and care, ADHD has been associated with a variety of negative child and adult outcomes. Environmental and familial factors that may contribute to three different pediatric referral types (academic, behavioural, and attentional) associated with ADHD were examined in the current study. In total, data from 477 families who were interviewed as a part of the intake process to a pediatric clinic were included in this study. Data for the current study was extracted from the intake questionnaires and included information on family history of mental health issues, socioeconomic status, and family relationships. The sample included children between the ages of three and 17 and mostly comprised males (n = 340). A frequency analysis of the data demonstrated relatively high rates of mental health issues within families (61.4%); almost half of the mothers reported some post-secondary education (46.1%) and most reported having normal relationships with their children (mothers, 78%; fathers, 62.9%). Finally, three stepwise regression analyses were conducted to predict referral type. All three regressions yielded significant models. Fifteen percent of the variability of the academic referral type was predicted by being male, age at the time of referral, mother’s education level, and mother’s learning. The behavioural referral types were predicted by a family history of depression, being male, mother-child relationship, and age at the time of referral; these accounted for 23% of the variance. Attentional referral type was predicted only by mother-child relationship that captured 6% of the variance. Overall, this study describes a population of parents of children with academic, behavioural, and attention-related referrals to pediatrics. Results indicate that mothers have a profound influence on their child’s referral types, something that may transfer into later diagnosis and perhaps prognosis. Clinicians and researchers alike should focus their efforts toward developing integrative service assessment and treatment approaches that include important people in the child’s life. The implementation of Community Social Pediatrics (a streamlined, inclusive approach to care) should be considered in urban centres like this one, where referrals like this are prevalent.

LO48: Similarities and differences between sports and recreation-related concussions and concussions from non-sport activities

Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( &amp;gt;17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-Concussion Questionnaire], and health-related quality of life [from the 12-Item Short Form Health Survey [SF-12]) were collected from structured interviews and the ED chart. Dichotomous and categorical variables were compared using Fisher's exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: In total, 248 patients were enrolled (47% male, median [IQR] age: 35 [23, 49]). Patients with SRC were younger (median: 23.5 years vs 35 years; p &amp;lt; 0.001), more likely to be a student (31% vs 8%; p &amp;gt; 0.001), and more likely to exercise regularly (89% vs 66%; p = 0.001). Patients with SRC were less likely to present during the daytime (66% vs. 77%; p = 0.022), less likely to have a history of mental health issues (18% vs 33%; p = 0.011) and had significantly higher median SF-12 physical components scores (55.5 [IQR: 51.4 to 57.8] vs. 53.5 [IQR: 45.5 to 56.7]; p = 0.025). All other characteristics were similar between the two groups. Conclusion: Although differences in demographics and lifestyle have been identified between patients sustaining a SRC and those concussed during other activities, injury characteristics, such as presentation acuity, proxies for severity, and signs and symptoms, were similar in both groups. Further analysis to assess whether the demographic and lifestyle differences affect clinical outcomes, such as time to symptom resolution, between these two groups is required to assess if sport-based treatment guidelines are appropriate for all patients.