Treatment Of Mental Health Disorders Research Articles

Psychiatric hospitalization among youth at high risk for HIV

ABSTRACT Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14–24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth.

Psychological Healthcare Burden Lessens After Hip Arthroscopy for Those With Comorbid Depression or Anxiety

PurposeIn this study, we investigated whether patients undergoing arthroscopic treatment of femoral acetabular impingement syndrome (FAIS) seek health care for treatment of comorbid depression and anxiety in the year following hip arthroscopy.MethodsUsing the Truven Health Marketscan database, FAIS patients who underwent hip arthroscopy between January 2009 and December 2016 were identified. Claims related to depression or anxiety filed during the year before surgery were required for inclusion. Using claims for pharmaceutical and psychological therapy treatments for mental health disorders, four groups of patients were analyzed on the basis of preoperative anxiety/depression treatment: medication only, therapy only, medication + therapy, and no treatment. Number of opioid pain prescriptions within 180 days prior to surgery and >90 days after hip arthroscopy were also compared.ResultsDepression and anxiety claims were identified in 5,208/14,830 (35.1%) patients. Preoperative treatment for depression and anxiety included medication only (n = 648, 12.4%), therapy only (n = 899, 17.3%), medication + therapy (n = 252, 4.8%), and no treatment (n = 3,409, 65.5%). Of the 900 patients who filled an anxiety/depression-related prescription prior to surgery, 422 (46.9%) patients did not fill a similar prescription in the postoperative year. Of the 1,151 patients receiving anxiety/depression-related therapy prior to surgery, 549 (47.7%) did not receive therapy in the postoperative year. Preoperative opioid prescriptions were filled for 393 patients (60.6%) in medication-only group, 275 (30.6%) in therapy-only group, 156 (61.9%) in medication + therapy group, and 1,059 (31.1%) in the group receiving no treatment. Opioid prescriptions >90 days postoperatively were filled for 330 (50.9%), 225 (25.0%), 120 (47.6%), and 861 (25.3%) patients, respectively.ConclusionHip arthroscopy for FAIS is associated with a decreased postoperative use of health care resources for the treatment of depression and anxiety. Clinicians should also be aware of the potential interplay between preoperative psychotropic medication use and prolonged opioid use when counseling patients.Level of EvidenceIV, therapeutic case series

L’impact de l’épidémie de COVID-19 sur les soins de premier recours en région Provence-Alpes-Côte d’Azur : retour d’expérience sur la mise en place d’un dispositif de surveillance en temps réel à partir des données régionales de l’Assurance maladie

BackgroundStarting in spring 2020, the COVID-19 pandemic markedly impacted the French healthcare system. Lockdown and risks of exposure to the coronavirus induced patients to modify their ways of use. The objective of this article was to share feedback on the implementation of a real-time monitoring system concerning (a) the activity of private practitioners in southeastern France, and (b) the evolution of reimbursements for drugs prescribed to persons with diabetes, for treatment of mental health disorders, and for performance of some vaccines. MethodsData regarding 2019 and 2020 were extracted from regional health insurance databases. They were used to elaborate several indicators relative to the general health insurance scheme, which were calculated and updated each week, starting with week 2. ResultsWe observed a drop in private physician activity during the lockdown (−23% for general practitioners; −46% for specialist doctors), followed by a return to a semblance of normalcy. Concomitantly, a boom in teleconsultations occurred: at the height of the crisis they represented 30% of medical acts. The initial stage of the lockdown was characterized by peak provisioning for drugs, whereas vaccination strongly declined (−39% regarding measles, mumps and rubella vaccine among children aged less than 5 years; −54% regarding human papillomavirus vaccine among girls aged 10 to 14 years). ConclusionThe COVID-19 pandemic could lead to health effects other than those directly attributable to the coronavirus itself. Renouncing care may result in healthcare delays highly deleterious for people and society. Public authorities are preoccupied with these questions; they have set up action plans aimed at encouraging patients to seek treatment without delay. That said, the COVID-19 pandemic crisis has also created opportunities, such as the expansion of telemedicine. Although partial, these indicators can provide useful information enabling public decision makers to be reactive and to implement specific actions to meet the health needs of the population.

Patient and Provider Experience of Electronic Patient Portals and Secure Messaging in Mental Health Treatment.

Objective: Electronic health record patient portals were promoted to enhance patient engagement. However, organizations often deny patient access to records of treatment for mental health disorders. This study explores patient and provider experience of patient electronic access to the mental health treatment record and the use of secure messaging. Materials and Methods: Online surveys of a sample of mental health patients (N = 168) and providers (N = 80) addressed their experience using patient portals and secure messaging. Results: Only 29 of the 80 providers (36%) worked at organizations which provided patients electronic access to mental health records. Of these 29 providers, 72% endorsed that patients requested a change in the provider note, 69% endorsed patients asked more questions, 55% endorsed patients reported they experienced significant distress after accessing portal, and 21% reported patients engaged in negative and/or self-destructive behavior toward themselves or others. Of patients with access to mental health notes (N = 37), 86% endorsed that they gained a better understanding of what was discussed in the appointment, 84% trusted their health care provider more, 76% felt comforted or relieved after reading their health information, and 57% reported they were better able to take medications as prescribed. Both patients and providers enjoyed the efficiency of secure messaging. Open-text responses are also presented. Conclusions: The implementation of electronic access to mental health notes requires a transition from viewing the medical record as the exclusive tool of providers to that of a collaborative tool for patients and providers to achieve treatment goals.

Digital psychiatry and COVID-19: a potential recruitment opportunity

Psychiatry has long been battling with a recruitment crisis in the UK which is also reflected across much of Europe. Covid-19 has brought about widespread changes to our ways of working, as well as driving technological developments, which provides potential opportunities for the profession to draw people into the speciality. Covid-19 has brought interest in digital psychiatry from the peripheries to the mainstream. Mental health professionals are currently using sophisticated technologies such as Virtual Reality, Artificial Intelligence and Natural Language Processing in the diagnosis and treatment of mental health disorders. Highlighting the ways in which our profession is at the cutting edge of innovation to junior doctors offers a fruitful avenue to improve recruitment into the speciality. Many outpatient clinics have made the move to online service delivery during the pandemic to varying degrees. For many clinicians this has allowed more flexible and efficient ways of working. Psychiatry is better placed than most other medical disciplines to retain online patient contact in future clinical practice, post pandemic and may provide an attractive proposition for future psychiatrists. This talk will review some of the ways in which developments in digital psychiatry have been used to help generate interest for recruitment into the discipline as well as evaluating the benefits and challenges of the shift to telepsychiatry during Covid-19 and will offer some suggestions what the profession can learn from this to help future recruitment.DisclosureNo significant relationships.

Integrating substance use care into primary care for adolescents and young adults: Lessons learned

BackgroundSubstance use disorders are common chronic conditions that often begin and develop during adolescence and young adulthood, yet the delivery of primary care is not developmentally tailored for youth who use substances. Very few primary care–based substance use treatment programs exist in the United States for adolescents and young adults and no clear guidance is available about how to provide substance use treatment in primary care. MethodsWe conducted a retrospective evaluation from July 2016 to December 2018 of a newly established primary care–based, multidisciplinary, outpatient program for youth who use substances. Components of the program include primary care, addiction treatment, harm reduction, naloxone distribution, psychotherapy, recovery support, and navigation addressing social determinants of health. We report the following patient characteristics and outcomes: demographics; proportion with substance use and mental health diagnoses; receipt of medications for opioid use disorder; retention in care at three, six, nine, and 12 months; and re-engagement in medical care. ResultsFrom July 2016 through December 2018, 148 patients had at least one visit. Demographic characteristics included: median age 21 years; 40.5% female; 94.0% spoke primarily English; 18.3% Black, 14.9% Hispanic, and 60.8% white. One-third of patients (33.8%) were homeless or housing insecure. The most common substance use disorder was opioid use disorder (60.8%), followed by nicotine (37.2%), cannabis (20.9%), and alcohol (18.2%). Overall, 29.7% of patients had depression, 32.4% had anxiety disorder, and 18.9% had post-traumatic stress disorder. Retention in care was 29.7% at six months and 12.2% at 12 months. Among the 90 patients with OUD, 90.0% received medication for OUD, and 35.5% and 15.5% of patients with OUD were retained at six and 12 months, respectively. For patients lost to follow-up (no contact during a three-month period), the median time to re-engagement was 4.8 months, and 33.3% (37/111) of patients re-engaged. The most common reason for re-engagement was to access mental health treatment (59.5%) and primary care (51.4%). ConclusionsYouth who sought care in a primary care–based substance use program presented most commonly with opioid, nicotine, cannabis, and alcohol use disorders. Co-morbid mental health diagnoses were common. While continuous retention at 12 months was low, one in three of the patients who fell out of care re-engaged. For youth receiving substance use care integrated into primary care, key components for pursing optimal retention in substance use treatment are a flexible model that anticipates the need for the treatment of mental health disorders and the use of re-engagement strategies.

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

The Rhythm is Gonna Get You: Social Rhythms, Sleep, Depressive, and Anxiety Symptoms

BackgroundSocial rhythmicity refers to the regularity with which one engages in social and lifestyle activities. Social rhythms have important implications for health and well-being including the prevention and treatment of mental health disorders. Existing research on social rhythmicity has focused on the link with bipolar disorder and, to a lesser extent, with depression. However, it is unclear how social rhythms are tied to anxiety disorders or what might mediate this association. Sleep shows potential as an underlying link, particularly sleep behaviors and sleep thoughts. MethodsThe current study used a sample of 3,284 adults to examine the role of sleep thoughts and behaviors as mediators of the association between social rhythms and mental health symptoms of depression and anxiety. ResultsParallel mediation models revealed that greater social rhythmicity is directly associated with fewer depressive and anxiety symptoms, and that healthier sleep behaviors and thoughts mediate this association. LimitationsThis study used cross-sectional data and was limited in racial and ethnic diversity. ConclusionsThe findings highlight the critical role lifestyle regularity plays in depressive and anxious symptom pathology in a large sample of adults across the lifespan. Results also highlight the complementary roles for both sleep behaviors and thoughts by demonstrating their concurrent links between regularity and mental health. Future work is needed to further disentangle the association of these constructs with mental health.

Annual Research Review: Immersive virtual reality and digital applied gaming interventions for the treatment of mental health problems in children and young people: the need for rigorous treatment development and clinical evaluation

Mental health problems in children and young people are common and can lead to poor long-term outcomes. Despite the availability of effective psychological interventions for mental health disorders, only a minority of affected children and young people access treatment. Digital interventions, such as applied games and virtual reality (VR), that target mental health problems in children and young people may hold a key to increasing access to, engagement with, and potentially the effectiveness of psychological treatments. To date, several applied games and VR interventions have been specifically developed for children and young people. This systematic review aims to identify and synthesize current data on the experience and effectiveness of applied games and VR for targeting mental health problems in children and young people (defined as average age of 18years or below). Electronic systematic searches were conducted in Medline, PsycINFO, CINAHL, and Web of Science. Nineteen studies were identified that examined nine applied games and two VR applications, and targeted symptoms of anxiety, depression, and phobias using both quantitative and qualitative methodologies. Existing evidence is at a very early stage and studies vary extensively in key methodological characteristics. For applied games, the most robust evidence is for adolescent depressive symptoms (medium clinical effect sizes). Insufficient research attention has been given to the efficacy of VR interventions in children and young people. The evidence to date is at a very early stage. Despite the enthusiasm for applied games and VR, existing interventions are limited in number and evidence of efficacy, and there is a clear need for further co-design, development, and evaluation of applied games and VR before they are routinely offered as treatments for children and young people with mental health problems.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

M.I.C.E\u2014Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy\u2014study protocol

BackgroundMental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone.MethodsIn total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed.DiscussionThis trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions.Trial registrationISRCTN ISRCTN57823197. Registered on 25 February 2019.

Evaluation and Treatment of Mental Health Disorders in College Students

Evaluation and Treatment of Mental Health Disorders in College Students

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a cross-sectional, nationally representative sample of adults in Great Britain, 2020.

In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co-use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non-smokers and (2) investigate mental health problems among non-users, tobacco-only, cannabis-only and co-users of both substances. Cross-sectional national on-line survey (Action on Smoking and Health) fielded in February-March 2020. Great Britain. Adults in Great Britain aged ≥18years (n=12 809) MEASUREMENTS: Tobacco use status [smoker (daily or non-daily) or non-smoker (never or ex-smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self-reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non-smokers [past-year: 4.7%; adjusted odds ratio (aOR)=10.07, 95% confidence interval (CI)=8.4-12.0; daily: 0.7%; aOR=24.6, 95% CI=18.0-33.6)]. Co-administration with tobacco was common (46.2% of non-smokers, 80.8% of tobacco smokers). Co-users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis-only (45.8%), tobacco-only (33.2%) and non-users (22.7%; all P≤0.05). Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non-smokers. Co-administration of cannabis and tobacco, via smoking, appears to be common, including among self-identified non-smokers. Mental health problems appear to be particularly common among dual users.

Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV.

People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.

FiD: a smartphone application for anxiety assessment: two weeks study

Anxiety disorders affect approximately one in six people, causing significant problems in their quality of life and that of their families with a significant percentage of mentally ill people not showing compliance with treatment or not receiving appropriate treatment. Research data therefore reveal the need to develop new and effective interventions that will improve the compliance and therapeutic management of the mentally ill. Because of the recent technological advancement, the field of electronic mental health applications (MHapps) offers unique opportunities which can contribute to self-management of mental health problems and patient compliance, as well as to development of preventive and therapeutic interventions. Mental health applications (MHapps) offer a unique opportunity for expanding availability and quality of treatment of mental health disorders, however few applications have been carefully assessed so far making their effectiveness questionable. The present study investigated the effect of MHapp FiD (Feel-Identity) on anxiety- an innovative electronic prototype application-in a sample of adults over a two-week period. Participants made daily use of the application, based on self-monitoring and self-recording in accordance with the Cognitive Behavioural Therapy protocol, with feedback interventions being fully automated. In order to investigate anxiety levels, the STAI questionnaire (State & Trait Anxiety Inventory) was administered over three different time periods: before the use of MHapp FiD, following the first week after its use, and following the second week after its use. The results between the 3 groups of application usage, showed a statistically significant decrease of the average TRAIT anxiety levels between the 1st and the 3rd administration, i.e., after two weeks of application usage, equal to -3.020 units (Mean Difference = -3.020, p-value = 0.006 <0.01), and a statistically significant drop of the average total anxiety levels, between the administration of the 2nd and the 3rd administration, i.e., over the second week of application usage, equal to -5.388 units (Mean Difference = -5.388, p-value = 0.029 <0.05). Τhere was no statistically significant difference as to the average STATE anxiety levels. The results showed a correlation between the daily use of the FiD application and the reduction of anxiety, providing a promising perspective for dissemination of the application in clinical populations with the addition of more functions and interventions.

Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review.

BackgroundInternet-delivered psychological treatments (IDPTs) are built on evidence-based psychological treatment models, such as cognitive behavioral therapy, and are adjusted for internet use. The use of internet technologies has the potential to increase access to evidence-based mental health services for a larger proportion of the population with the use of fewer resources. However, despite extensive evidence that internet interventions can be effective in the treatment of mental health disorders, user adherence to such internet intervention is suboptimal.ObjectiveThis review aimed to (1) inspect and identify the adaptive elements of IDPT for mental health disorders, (2) examine how system adaptation influences the efficacy of IDPT on mental health treatments, (3) identify the information architecture, adaptive dimensions, and strategies for implementing these interventions for mental illness, and (4) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues.MethodsThe review followed the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research databases Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL, and Cochrane were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analyzed.ResultsA total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were selected, most of which described attempts to tailor interventions for mental health disorders. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies was tunnel-based, although a number of studies did not report the choice of information architecture used. Rule-based strategies were the most common adaptive strategies used by these studies. All of the studies were broadly grouped into two adaptive dimensions based on user preferences or using performance measures, such as psychometric tests.Conclusions Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in IDPT systems. Hence, focused research on adaptive IDPT systems and clinical trials to assess their effectiveness are needed.

Managing COVID + ve patients on inpatient adolescent psychiatry unit- A unique challenge

The Corona virus disease 2019 (COVID-19) has had a profound impact on the physical as well as mental well-being of people around the globe. The response to and resulting consequences of the COVID-19 pandemic poses significant challenges for patients suffering from mental health disorders as demonstrated by a recent study by Xie et al. examining adult COVID-19 patients admitted for inpatient psychiatric treatment for first-episode mental health issues [1]. Children, too, have the potential to experience adverse mental health outcomes due to distress resulting from the pandemic: a study by Jolly et al. examined recently surfacing reports on varied presentations of pediatric patients undergoing hospitalization in psychiatry hospitals in context of COVID-19. One major source of stress is the institution of widespread social distancing practices as schools have transitioned to partial or full-time virtual learning [2]. In addition, extracurricular activities have undergone restrictions or been canceled entirely and in-person contact with peers and other important social supports has been limited. These changes place strain on children which can lead to distress and worsening mental health outcomes [2]. The pandemic has also caused significant economic stress for many families. Increased unemployment, forced changes in interpersonal interactions, the wide-ranging effects caused by the safety measures being taken in response to COVID-19, and even concern over COVID-19-related illness or death itself may directly impact the mental health of children as well as indirectly impacting their mental health due to increased stress experienced by parents and the family as a whole [2]. Moreover, children who become COVID-positive and are subject to specific safety protocols in their care are under additional pressure that can further exacerbate mental health problems related and unrelated to the COVID-19 pandemic. There have been limited studies evaluating the treatment of COVID-19 pediatric patients admitted for the treatment of mental health disorders [3,4]. Here we present two cases of COVID-positive pediatric patients in an inpatient psychiatric facility and how the milieu was changed around them.

REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial.

BackgroundEmotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention.ObjectiveThe aim of this study is to examine, for the first time, a new internet-based intervention—REMOTION—that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format.MethodsA total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis.ResultsParticipant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022.ConclusionsThis pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment.Trial RegistrationClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726International Registered Report Identifier (IRRID)DERR1-10.2196/20936

Mental Health Services in the United States Public High Schools.

Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime.