This study examined changes in utilization of mental health services after Hurricane Katrina among children with preexisting conditions who were displaced from their homes in Louisiana disaster ...counties and resettled in Texas.
A retrospective analysis was performed on Medicaid claims data for 101,950 children from 2004 to 2006. Pre-post changes in utilization of mental health services by the displaced children and three control groups were compared. The control groups were children from Louisiana disaster counties who were not displaced, Louisiana children from nondisaster counties, and Texas children enrolled in Medicaid.
The proportion of children who had a prescription fill for psychotropic medication and the average days' supply per child decreased in each group, but the decreases were significantly larger for the displaced group than for the control groups. The decreases in both measures were largest for stimulants and antidepressants, the two most common medication classes. By contrast, changes in the proportion of children with an encounter involving psychiatric services and the average number of psychiatric services encounters per child did not vary systematically across the displaced and control groups.
The contrast between the results for medication utilization and encounters reveals a potential gap in post-Katrina provision of care. Although the findings for encounters indicate that, on average, displaced children did not experience a disruption in provider visits, the medication estimates suggest that they often did not obtain pharmaceutical treatment. Future disaster responses may be improved by addressing logistical impediments faced by disaster victims in filling their prescriptions for psychiatric medications.
Abstract
Background
Prior estimates of the years of life lost (YLLs) in the USA associated with coronavirus disease 2019 (COVID-19) were 1.2 million through 11 July 2020 and 3.9 million through 31 ...January 2021 (which roughly coincides with the first full year of the pandemic). The aim of this study is to update YLL estimates through the first 2 years of the pandemic.
Methods
We employed data regarding COVID-19 deaths through 5 February 2022 by jurisdiction, gender and age group. We used actuarial life expectancy tables by gender and age to estimate YLLs.
Results
We estimated roughly 9.7 million YLLs due to COVID-19 deaths. The number of YLLs per 10 000 capita was 297.5, with the highest rate in Mississippi (482.7) and the lowest in Vermont (61.4). There was substantial interstate variation in the timing of YLLs and differences in YLLs by gender. YLLs per death increased from 9.2 in the first year of the pandemic to 10.8 through the first 2 years.
Conclusions
Our findings improve our understanding of how the mortality effects of COVID-19 have evolved. This insight can be valuable to public health officials as the disease moves to an endemic phase.
Purpose:
Using data from a randomized clinical trial evaluating cognitive behavioral therapy (CBT) for children with autism and co-occurring anxiety, this study examined the relationship between ...autism features and anxiety symptoms throughout CBT.
Methods:
Two multilevel mediation analyses were run which examined the mediating role of changes in anxiety for changes in two core features of autism, (a) repetitive and restrictive behaviors (RRBs) and (b) social communication/interaction impairments, between pre- and post-treatment.
Results:
Indirect effects between time and autism characteristics were significant for both models, indicating that as anxiety changes, so do RRBs and social communication/interaction as the outcomes respectively.
Conclusion:
Findings suggest a bidirectional relationship between anxiety and autism features. Implications of these findings are discussed.
Background: Higher subjective social status (SSS) is associated with better mental health among youth; however, few studies have examined youth's perceptions of past (childhood) or future (adulthood) ...SSS. Methods: Utilizing latent profile analysis, we examined unique profiles of past, present, and future SSS among 401 college students in the United States and tested associations between these profiles and psychological well-being (ie, depressive symptoms, negative affect, positive affect, and flourishing), controlling for family socioeconomic status (SES). Results: Results revealed four profiles: Low SSS (8%), Upward SSS (18%), Moderate SSS (43%), and High SSS (31%). Youth in the High SSS profile had the best psychological well-being, and those in the Low SSS profile had the worst. While the Upward SSS profile was associated with depressive symptoms and negative affect, it was protective in terms of positive affect. Discussion: Findings highlight unique effects of upward SSS mobility.
Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1954010
Abstract Objective While individual trials suggest benefit of interventions for excoriation (skin-picking) disorder (ExD), limited systematic evaluation of treatments, or their collective benefit, ...exists. Methods The present study examined the current state of treatments for ExD in a systematic review and meta-analysis and explored potential treatment moderators. Twelve trials were identified for review, including five with a control condition. Of these, nine were eligible to be included in the meta-analysis (three with a control). Results A fixed-effects meta-analysis found a large overall treatment effect size ( g = 1.13), comprised of large effects for behavioral treatments ( g = 1.19), lamotrigine ( g = 0.98) and selective serotonin reuptake inhibitors ( g = 1.09). Clinician-rated measures did not significantly differ from self-rated measures; however, larger effects were observed on self-rated measures of severity, as compared to impairment Q(1) = 4.63, P = .03. Treatment type, trial length and trial methodological quality were not significant moderators. For controlled trials, the comparative efficacy of treatments for ExD was in the moderate range ( g = 0.47). Conclusion Findings suggest that treatment for ExD has benefit; however, the meta-analysis did not provide strong evidence to support any specific treatment or to suggest its unique clinical benefit over control conditions. Overall, there is a lack of study on treatments for ExD and additional randomized controlled trials with inclusion of multiple informants in assessment is needed.
Background
Therapeutic alliance and decreases in negative cognitions may play an important role in the outcomes of child trauma-focused cognitive behavioral therapy. However, understanding alliance ...from multiple perspectives (i.e., therapist, parent, and child) and if changes in negative cognitions differ by type of delivery is limited.
Objective
The current study examined therapist, parent and child therapeutic alliance and child negative cognition changes over time and as potential mediators of outcomes between Step One, a parent-led therapist-assisted cognitive behavioral therapy (CBT), and therapist-led Trauma-Focused CBT (TF-CBT).
Methods
Therapist, parent and child therapeutic alliance, child negative cognitions, child posttraumatic stress symptoms (PTSS) and impairment were assessed at the first session, mid-treatment and near the end of treatment among child-parent dyads in Step One (
n
= 43) and TF-CBT (
n
= 71). Child PTSS and impairment were also assessed at post-treatment.
Results
The rate of change in therapist and parent therapeutic alliance within Step One and TF-CBT did not significantly differ. Changes over time in child alliance ratings differed with a convex curve for Step One and a concave curve for TF-CBT children. Similar decreases in negative cognitions in Step One and TF-CBT children occurred. Neither therapeutic alliance (therapist, parent, and child) nor negative cognitions were mediators of PTSS and impairment outcomes. Therapist therapeutic alliance over time, across treatments was a predictor of child PTSS.
Conclusions
Change rates in child therapeutic alliance differs with a parent-led therapist-assisted treatment versus TF-CBT. Therapist alliance may influence child PTSS outcomes in a parent-led and therapist-led CBT treatment.
Clinical Trial Registration Information
Stepped Care for Children after Trauma: Optimizing Treatment:
https://clinicaltrials.gov
: NCT02537678.
Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to ...investigate the internal structure of these dimensions in unselected schoolchildren and in children with OCD.
We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 children diagnosed with OCD from 18 sites across 6 countries. All participants completed the Obsessive-Compulsive Inventory-Child Version.
In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, that is, having strong connections to other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, sexes, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and sex in the school-based but not the clinic-based samples.
The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.
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