Referral For Mental Health Treatment Research Articles

Multisite examination of depression screening scores and correlates among adolescents and young adults with type 2 diabetes

Abstract Objectives Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. Methods The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. Results Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. Conclusions Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.

Does past depression predict present depression among HIV test-seekers?

ABSTRACT Previous research has indicated that major depression is a chronic illness with people experiencing several depressive episodes over the course of their lifetime. To this extent people who currently report major depression are more likely to enter and exit future depressive episodes than those who do not. We studied 500 South Africans seeking an HIV test to determine whether past depressive disorders predicted present depression. Among our sample, 14.40% met the diagnostic criteria for current major depression and 10.42% reported past major depression. Using chi-square analysis we found that study participants with current major depression were 9.25 times more likely to have had past major depression than those without past major depression. These results have important implications for HIV care. Persons who test positive for HIV and who have major depression are less likely to accept and adhere to antiretroviral therapy. Thus identifying positive cases of depression and thus the risk of future depressive episodes among this population will enhance the likelihood of referral for mental health treatment which in turn is likely to yield improved HIV treatment outcomes.

Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes

ObjectivesOur aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. MethodsThe Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. ResultsAdolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. ConclusionsScreening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.

830-P: Screening for Depressive Symptoms in Adolescent Type 2 Diabetes Point to a Need for Improvement in Clinical Processes and Resources

Objective: To document rates of elevated depressive symptoms endorsed during routine screening for adolescents and young adults (AYA) with type 2 diabetes (T2D), review clinical actions taken in response to screening results, and evaluate associations of depressive symptoms with AYA characteristics. Research Design and Methods: The Patient Health Questionnaire (PHQ) was administered to 218 AYA with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centers. Data from electronic health records were collected from the screening date and 12 months prior. Results: The mean age was 16.77 (SD 2.10 years); 56% male; 74% non-Hispanic White; Mean T2D duration 3.48 (SD 2.51 years). On the PHQ, 21.6% of AYA with T2D endorsed elevated depressive symptoms (PHQ score≥10) and 15.2% endorsed thoughts of self-harm. Older age, shorter T2D duration, not on insulin, and more blood glucose checks per day were significantly associated with more depressive symptoms. Of those AYAs endorsing the harm-to-self item, 8.3% were in mental health treatment. For AYAs expressing harm-to-self who were not in treatment (91.7%),18.2% did not have a documented referral for mental health treatment in the medical record. Conclusions: Screening for depressive symptoms identifies individuals in need of referral for mental health treatment; however, a focus on self-harm assessment, standardized methods for documentation of symptoms, mental health referrals and increased referral resources are needed. Disclosure J.Y. Stone: None. S.A. Mulvaney: None. C.A. Mara: None. J.C. Kichler: None. S. Majidi: Advisory Panel; Self; Companion Medical. K.A. Driscoll: None. S.C. Westen: None. A. Rawlinson: None. L.M. Jacobsen: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M. Monaghan: Research Support; Self; American Diabetes Association. R.N. Adams: Employee; Self; Virta Health Corp. Funding National Center for Advancing Translational Sciences (UL1TR002243, UL1TR001427)

Sexual minority children: Mood disorders and suicidality disparities.

Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants. Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (nunweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (nunweighted = 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable. The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%). Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities. Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9-10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated.

Teachers’ Knowledge of Anxiety and Identification of Excessive Anxiety in Children

This study examined primary school teachers' knowledge of anxiety and excessive anxiety symptoms in children. Three hundred and fifteen primary school teachers completed a questionnaire exploring their definitions of anxiety and the indications they associated with excessive anxiety in primary school children. Results showed that teachers had an understanding of what anxiety was in general but did not consistently distinguish normal anxiety from excessive anxiety, often defining all anxiety as a negative experience. Teachers were able to identify symptoms of excessive anxiety in children by recognizing anxiety-specific and general problem indications. The results provided preliminary evidence that teachers' knowledge of anxiety and anxiety disorders does not appear to be a barrier in preventing children's referrals for mental health treatment. Implications for practice and directions for future research are discussed.

Anxiety and depression in Australian chronic hepatitis C outpatients: prevalence and predictors

The present study aimed to assess the prevalence and predictors of anxiety and depression in Australian chronic hepatitis C (CHC) outpatients. Hospital Anxiety and Depression Scale scores at referral and other patient data was analysed for 395 CHC outpatients attending the Royal Adelaide Hospital liver clinic from 2006 to 2010. Results revealed probable prevalence rates of 41% for anxiety and 27% for depression. CHC patients had rates of anxiety and depression 1.2 and 2.4 times higher than community norms, respectively. Younger patients were found to experience increased anxiety, while married patients or those in a de facto relationship experienced decreased anxiety and depression. Regular psychiatric screening, and subsequent referral for mental health treatment, where necessary, is recommended for Australian CHC patients. Younger patients or those lacking social supports may be at increased risk. Research is needed to develop and evaluate psychological interventions.

Peanut Allergy in Children

Peanut allergy prevalence appears to be increasing in the pediatric population and pediatricians need to be aware how it may affect children's psychological functioning. This study examined relationships between health-related quality of life, child anxiety, and parental stress in children with peanut allergy. A total of 51 families completed questionnaires regarding child anxiety, parenting stress, and quality of life. Child anxiety and parenting stress were found to significantly predict parent proxy report of their child's health-related quality of life. Child anxiety, parenting stress, length of diagnosis, and experiencing an epinephrine shot predicted self-report of health-related quality of life. Although many children with peanut allergy function well, a certain subset of children and families appear to experience high levels of parenting stress and high levels of child anxiety that can affect health-related quality of life and these children may require referrals for mental health treatment.

SEPARATION ANXIETY DISORDER IN YOUTH: PHENOMENOLOGY, ASSESSMENT, AND TREATMENT.

Separation Anxiety Disorder (SAD) is the most commonly diagnosed and impairing childhood anxiety disorder, accounting for approximately 50% of the referrals for mental health treatment of anxiety disorders. While considered a normative phenomenon in early childhood, SAD has the potential to negatively impact a child's social and emotional functioning when it leads to avoidance of certain places, activities and experiences that are necessary for healthy development. Amongst those with severe symptoms, SAD may result in school refusal and a disruption in educational attainment. This paper provides a comprehensive review of the current literature on SAD etiology, assessment strategies, and empirically supported treatment approaches. New and innovative approaches to the treatment of SAD that also employ empirically supported techniques are highlighted. In addition, future directions and challenges in the assessment and treatment of SAD are addressed.

IS ADOPTION A RISK FACTOR FOR THE DEVELOPMENT OF ADJUSTMENT PROBLEMS?

The extent to which being adopted increases a child's risk for the development of adjustment problems has been debated for decades. Results from studies examining prevalence of adopted children and adolescents in outpatient and inpatient mental health treatment suggest that the risk associated with adoption is modest or nonexistent. This body of research is reviewed and critiqued. Two possible explanations for the apparent disparate findings of the clinically based and nonclinically based studies are explored: biases in referral for mental health treatment and the influence of the shape of the distribution of adjustment problems in the adopted and nonadopted populations. Implications for clinical practice and future research are explored.

Post-traumatic stress disorder and the elderly combat veteran.

1 PTSD has been an under-diagnosed syndrome among World War II and Korean era veterans both because of clinical inattention and the way this generation of soldiers coped with traumatic memories throughout their lives. 2 There are psychological, developmental, and situational factors that may cause PTSD symptoms to resurface among older veterans in health care settings. 3 Nurses in health care settings who have frequent contact with the elderly are in a unique position to identify older veterans who might be at risk for resurfacing of PTSD symptoms and to provide limited assistance and referral for mental health treatment.