Alexa Bagnell

Telephone-Based Mental Health Interventions for Child Disruptive Behavior or Anxiety Disorders: Randomized Trials and Overall Analysis

OBJECTIVE Most children with mental health disorders do not receive timely care because of access barriers. These initial trials aimed to determine whether distance interventions provided by nonprofessionals could significantly decrease the proportion of children diagnosed with disruptive behavior or anxiety disorders compared with usual care. METHOD In three practical randomized controlled trials, 243 children (80 with oppositional-defiant, 72 with attention-deficit/hyperactivity, and 91 with anxiety disorders) were stratified by DSM-IV diagnoses and randomized to receive the Strongest Families intervention (treatment) or usual care (control). Assessments were blindly conducted and evaluated at 120, 240, and 365 days after randomization. The intervention consisted of evidence-based participant materials (handbooks and videos) and weekly telephone coach sessions. The main outcome was mental health diagnosis change. RESULTS Intention-to-treat analysis showed that for each diagnosis significant treatment effects were found at 240 and 365 days after randomization. Moreover, in the overall analysis significantly more children were not diagnosed as having disruptive behavior or anxiety disorders in the treatment group than the control group (120 days: χ(2)(1) = 13.05, p < .001, odds ratio 2.58, 95% confidence interval 1.54-4.33; 240 days: χ(2)(1) = 20.46, p < .001, odds ratio 3.44, 95% confidence interval 1.99-5.92; 365 days: χ(2)(1) = 13.94, p < .001, odds ratio 2.75, 95% confidence interval 1.61-4.71). CONCLUSIONS Compared with usual care, telephone-based treatments resulted in significant diagnosis decreases among children with disruptive behavior or anxiety. These interventions hold promise to increase access to mental health services. CLINICAL TRIAL REGISTRATION INFORMATION Strongest Families: Pediatric Disruptive Behaviour Disorder, http://www.clinicaltrials.gov, NCT00267579; Strongest Families: Pediatric Attention-Deficit/Hyperactivity Disorder, http://www.clinicaltrials.gov, NCT00267605; and Strongest Families: Pediatric Anxiety, http://www.clinicaltrials.gov, NCT00267566.

Factorial validity of the Center for Epidemiological Studies Depression 10 in adolescents.

The Center for Epidemiological Studies-Depression (CES-D) Scales 20-item version is well-validated and reliable for detecting depressive symptoms in adolescents in community samples. A shortened version, CES-D 10 has not been validated with adolescents, but has demonstrated strong psychometrics in other populations. The purpose of this study was to test the factorial validity and internal consistency of the CES-D 10 in adolescents. Using data from 156 adolescents in a previous community-based study, we tested three models of the underlying factors of the CES-D 10 using Structural Equation Modeling (SEM) based on factor models validated in other populations. A two-factor model comprised of depressive affect and positive affect was found to be the model that best fits the data (RMSEA = 0.016, CFI = 0.98, GFI = 0.95, AIC = 97.43, BIC = 191.98). These findings are consistent with other studies in adults and provide initial support for the use of the CES-D 10 as a depression screen for adolescents in the community. The utility of a brief screen for adolescents in the community is high, given that many adolescents do not know they need help or are reluctant to seek help. The CES-D 10 could be used as a depression screen for adolescents at a population level and in health clinics.

A youth suicide prevention plan for Canada: a systematic review of reviews

Objective: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. Methods: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. Results: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. Conclusions: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness

BackgroundSevere mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early developmental antecedents to SMI are likely to be more malleable than fully developed mood or psychotic disorders and that low-risk interventions targeting antecedents may reduce the risk of SMI.Methods/DesignFamilies Overcoming Risks and Building Opportunities for Well-being (FORBOW) is an accelerated cohort study that includes a large proportion of offspring of parents with SMI and embeds intervention trials in a cohort multiple randomized controlled trial (cmRCT) design. Antecedents are conditions of the individual that are distressing but not severely impairing, predict SMI with moderate-to-large effect sizes and precede the onset of SMI by at least several years. FORBOW focuses on the following antecedents: affective lability, anxiety, psychotic-like experiences, basic symptoms, sleep problems, somatic symptoms, cannabis use and cognitive delay. Enrolment of offspring over a broad age range (0 to 21 years) will allow researchers to draw conclusions on a longer developmental period from a study of shorter duration. Annual assessments cover a full range of psychopathology, cognitive abilities, eligibility criteria for interventions and outcomes. Pre-emptive early interventions (PEI) will include skill training for parents of younger children and courses in emotional well-being skills based on cognitive behavioural therapy for older children and youth. A sample enriched for familial risk of SMI will enhance statistical power for testing the efficacy of PEI.DiscussionFORBOW offers a platform for efficient and unbiased testing of interventions selected according to best available evidence. Since few differences exist between familial and ’sporadic’ SMI, the same interventions are likely to be effective in the general population. Comparison of short-term efficacy of PEI on antecedents and the long term efficacy for preventing the onset of SMI will provide an experimental test of the etiological role of antecedents in the development of SMI.

Early temperament prospectively predicts anxiety in later childhood.

Objective: To investigate the contribution of early childhood temperamental constructs corresponding to 2 subtypes of general negative emotionality—fearful distress (unadaptable temperament) and irritable distress (fussy–difficult temperament)—to later anxiety in a nationally representative sample. Method: Using multiple linear regression analyses, we tested the hypothesis that caregiver-reported child unadaptable temperament and fussy–difficult temperament scales of children aged 2 to 3 years (in 1995) would prospectively predict caregiver-reported child anxiety symptoms at ages 4 to 5, 6 to 7, 8 to 9, and 10 to 11 years, and child-reported anxiety at 10 to 11 years (controlling for sex, age, and socioeconomic status) in a nationally representative sample from Statistics Canadas National Longitudinal Survey of Children and Youth (initial weighted n = 768 600). Results: Only fussy–difficult temperament predicted anxiety in children aged 6 to 7 years. In separate regressions, unadaptable temperament and fussy–difficult temperament each predicted anxiety at 8 to 9 years, but when both were entered simultaneously, only unadaptable temperament remained a marginal predictor. Temperament did not significantly predict caregiver- or child-reported anxiety at 10 to 11 years, suggesting that as children age, environmental factors may become more important contributors to anxiety than early temperament. Conclusion: Our results provide the first demonstration that early temperament is related to later childhood anxiety in a nationally representative sample.

Enhancig the Effectivencess and Sustainability of School-Based Mental Health Programs: Maximizing Program Participation, Knowledge Uptake and Ongoing Evaluation using Internet-Based Resources

School-based mental health initiatives designed to address mental health difficulties in young people face a number of challenges that can limit their effectiveness and sustainability. These include challenges to participation, challenges to knowledge uptake and challenges to timely and ongoing evaluation. In this paper, we review how each of these challenges affects the effectiveness of school-based mental health programs and how they can be addressed, in part, through interactive, internet-based resources and tools, while maximizing the sustainability of those programs. Never before has a single delivery system such as the internet had the capacity to reach such a large number of young people simultaneously.

Treating child and adolescent anxiety effectively: Overview of systematic reviews ☆

We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.

Maximizing the Uptake and Sustainability of School-Based Mental Health Programs: Commercializing Knowledge

Clear benefits of school-based interventions focusing on health and mental health promotion or illness have been documented. A number of permanent repositories that rate and list effective school-based programs have been established. However, efforts to implement programs on a mass scale have not succeeded. There is a need to balance program development and improvement with uptake and implementation. This article outlines what is known about knowledge exchange and mobilization and introduces a business lens for school-based mental health programs uptake and sustainability. Individual clinicians can have significant impact by promoting strategies for both patients and the whole school population.

Building Mental Health Literacy: Opportunities and Resources for Clinicians

Youth mental health is increasingly recognized as a key concern with significant impact on youth and society. School is the one setting where professionals are consistently available to monitor how children are functioning and learning and intervene and support. School psychiatry has expanded beyond individual mental health problems to school-wide and community issues including school violence, sexual harassment, bullying, substance abuse, discrimination, and discipline. This article describes the importance of mental health literacy in health outcomes and research in school-based mental health programs to better position the clinician to advocate at the individual and/or system level.

Disruptive mood dysregulation disorder in offspring of parents with depression and bipolar disorder

BackgroundIt has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.AimsWe examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major depressive disorder and (c) a control group with no mood disorders.MethodWe established lifetime diagnosis of DMDD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children for DSM-5 in 180 youth aged 6-18 years, including 58 offspring of parents with bipolar disorder, 82 offspring of parents with major depressive disorder and 40 control offspring.ResultsDiagnostic criteria for DMDD were met in none of the offspring of parents with bipolar disorder, 6 of the offspring of parents with major depressive disorder and none of the control offspring. DMDD diagnosis was significantly associated with family history of major depressive disorder.ConclusionsOur results suggest that DMDD is not specifically associated with a family history of bipolar disorder and may be associated with parental depression.