Nicole E. Mahrer

Overview of Meta-Analyses of the Prevention of Mental Health,Substance Use and Conduct Problems

This review presents findings from an overview of meta-analyses of the effects of prevention and promotion programs to prevent mental health, substance use, and conduct problems. The review of 48 meta-analyses found small but significant changes that reduce depression, anxiety, antisocial behavior, and substance use. Furthermore, the results were sustained over time. Meta-analyses often found that the effects were heterogeneous. A conceptual model is proposed to guide the study of moderators of program effects in future meta-analyses, and methodological issues in synthesizing findings across preventive interventions are discussed.

Pediatric chronic pain and health-related quality of life.

The aim of this study was to investigate the health-related quality of life (HRQOL) of children and adolescents with chronic pain. Sixty-nine participants (53 girls and 16 boys, 8-18 years old) were recruited, along with their caregivers, from an outpatient pain management clinic. Participants completed questionnaires regarding the childs pain intensity and HRQOL (physical, emotional, social, and school functioning). Findings indicated that children with chronic pain report significantly lower HRQOL scores compared to population-based normative data and data of children with other chronic illnesses. Lower levels of pain were associated with higher HRQOL scores. In addition to targeting pain management, interventions focused on emotional health are necessary to enhance health outcomes for children with chronic pain.

Fifteen-year follow-up of a randomized trial of a preventive intervention for divorced families: effects on mental health and substance use outcomes in young adulthood.

OBJECTIVE This 15-year follow-up assessed the effects of a preventive intervention for divorced families, the New Beginnings Program (NBP), versus a literature control condition (LC). METHOD Mothers and their 9- to 12-year-olds (N = 240 families) participated in the trial. Young adults (YAs) reported on their mental health and substance-related disorders, mental health and substance use problems, and substance use. Mothers reported on YAs mental health and substance use problems. Disorders were assessed over the past 9 years (since previous follow-up) and 15 years (since program entry). Alcohol and marijuana use, other substance use and polydrug use, and mental health problems and substance use problems were assessed over the past month, past year, and past 6 months, respectively. RESULTS YAs in NBP had a lower incidence of internalizing disorders in the past 9 years (7.55% vs. 24.4%; odds ratio [OR] = .26) and 15 years (15.52% vs. 34.62%; OR = .34) and had a slower rate of onset of internalizing symptoms associated with disorder in the past 9 years (hazard ratio [HR] = .28) and 15 years (HR = .46). NBP males had a lower number of substance-related disorders in the past 9 years (d = 0.40), less polydrug (d = 0.55) and other drug use (d = 0.61) in the past year, and fewer substance use problems (d = 0.50) in the past 6 months than LC males. NBP females used more alcohol in the past month (d = 0.44) than LC females. CONCLUSIONS NBP reduced the incidence of internalizing disorders for females and males and substance-related disorders and substance use for males.

Relations Between Anxiety Sensitivity, Somatization, and Health-Related Quality of Life in Children With Chronic Pain

OBJECTIVE To further understand the influence of psychological variables on pain and functioning in children with chronic pain by examining the relations between pain, anxiety sensitivity (AS), somatization, and health-related quality of life (HRQOL), and whether they vary as a function of age and gender. METHODS 66 children (8-12 years) and adolescents (13-18 years) with chronic pain completed measures assessing pain intensity, AS (childhood anxiety sensitivity index), somatization (child somatization inventory), and HRQOL (pediatric quality of life inventory 4.0). RESULTS Somatization was significantly related to higher pain intensity. Somatization significantly predicted HRQOL over and above pain. AS was a significant predictor of impaired HRQOL for children and females in the sample, but not for adolescents or males. CONCLUSION Somatization and AS may be better predictors of HRQOL impairment than pain intensity in children with chronic pain. This may differ as a function of age and gender.

Psychosocial and behavioral outcomes in children with sickle cell disease and their healthy siblings

The current study aims to compare positive and negative measures of psychosocial functioning among children with sickle cell disease (SCD) and their healthy siblings. Participants were 41 African-American children with SCD, 97 healthy siblings, and their primary caregivers. Primary caregivers completed self-report questionnaires assessing child behavioral problems, while children with SCD and siblings completed self-report questionnaires assessing coping, self-efficacy, and perceived social support. No significant differences were noted between children with SCD and their siblings on all measures. Both groups reported self-efficacy and perceived social support within the normative range, and endorsed significantly greater use of Positive/Approach coping. In general, both groups of children do not have clinically significant behavioral problems. However, secondary exploratory analyses identified that a greater percentage of children from both groups scored above the established clinical cutoff on the behavioral summary scores. Number of visits to the emergency room was related to behavioral problems in children with SCD. While previous reports have been mixed in their findings that children with SCD are at greater risk for psychosocial and other behavioral problems, the current report finds that children with SCD and their healthy siblings endorse positive psychosocial functioning and as a group do not have clinically significant behavioral problems. Nonetheless, ongoing psychosocial evaluation for children receiving treatment for SCD is vital.

State trait anxiety in the emergency department: an analysis of anticipatory and life stressors.

Objective: To determine the relationship between stress indicators and state anxiety among pediatric emergency department (ED) patients, as a background to develop appropriate psychoeducational and behavioral interventions. Methods: Patients with nonchronic conditions aged 10 to 18 years completed questionnaires assessing demographics; (8) life stressors (LSs), such as death in family and marital separation/divorce; (10) anticipatory stressors (ASs) such as fear of needles, blood, or undressing; and the State Trait Anxiety Inventory for Children (a 20-item validated tool). Results: One hundred patients completed the study: the mean age was 13.3 years; 56% were female; and 90% were Latino patients. Notable life stressors (mean, 1.83) included: change in school location (24%), change in school performance (29%), death in family (33%), and marital separation/divorce (48%). Common AS (mean, 4.76) included worry about shots (33%), strangers (41%), talking about personal problems (44%), separation from parents (51%), undressing (56%), hospitalization (57%), and pain (73%). Significant correlations were found between age and state anxiety (r, −0.21; P < 0.05), age and AS (r, −0.38; P < 0.001), and AS and state anxiety (r, 0.20; P < 0.05). Patients with clinical state anxiety (36%) were more likely to be in the ED with a complaint of pain and/or trauma, had significantly more AS (t, 2.1; P < 0.05), and worry about parental separation (&khgr;2, 5.5; P < 0.05) and blood tests (&khgr;2, 4.9; P < 0.05) than patients with subclinical state anxiety. Conclusions: The ED experience produces fear/anxiety, particularly in younger patients with a chief complaint of pain and/or trauma. Findings may lead to the development of psychoeducational and behavioral interventions that focus on anxiety reduction.

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later.

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation. Design: Divorced mothers and children (age 9–12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families. Main Outcome Measures: Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task. Results: Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group. Conclusions: Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.

Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management

Objective To conduct a randomized control trial to evaluate the feasibility and efficacy of virtual reality (VR) compared with standard of care (SOC) for reducing pain, anxiety, and improving satisfaction associated with blood draw in children ages 10-21 years. Methods In total, 143 triads (patients, their caregiver, and the phlebotomist) were recruited in outpatient phlebotomy at a pediatric hospital and randomized to receive either VR or SOC when undergoing routine blood draw. Patients and caregivers completed preprocedural and postprocedural standardized measures of pain, anxiety, and satisfaction, and phlebotomists reported about the patients experience during the procedure. Results Findings showed that VR significantly reduced acute procedural pain and anxiety compared with SOC. A significant interaction between patient-reported anxiety sensitivity and treatment condition indicated that patients undergoing routine blood draw benefit more from VR intervention when they are more fearful of physiological sensations related to anxiety. Patients and caregivers in the VR condition reported high levels of satisfaction with the procedure. Conclusion VR is feasible, tolerated, and well-liked by patients, caregivers, and phlebotomists alike for routine blood draw. Given the immersive and engaging nature of the VR experience, VR has the capacity to act as a preventive intervention transforming the blood draw experience into a less distressing, potentially pain-free routine medical procedure, particularly for pediatric patients with high anxiety sensitivity. VR holds promise to reduce negative health outcomes for children and reduce distress in caregivers, while facilitating increased satisfaction and throughput in hectic outpatient phlebotomy clinics.

Occult psychosocial impairment in a pediatric emergency department population.

Objectives We compared the degree of psychosocial impairment in patients seen in the emergency department (ED) for acute complaints with that of patients presenting with chronic complaints using the Youth Pediatric Symptom Checklist (PSC-Y). Our hypothesis was that patients with multiple visits for chronic complaints (>3 health care visits for the chief complaint during the previous 12 months) would be more likely than patients with acute complaints to test positive for psychosocial issues. Methods The PSC-Y was administered to patients aged 8 to 18 years presenting to a pediatric ED for nonpsychiatric complaints. We compared proportions of patients testing positive for psychosocial impairment on the PSC-Y or any of its subscales. Results In the 442 patients enrolled, 25% endorsed chronic symptoms. There was a significant difference in the proportion of patients scoring positive for psychosocial impairment between the acute and chronic group (13.8% vs 18.1%, P = 0.002) as well as in the proportion of patients testing positive for attentional issues (6.4% vs 13.9%, P = 0.02). Each subscale was analyzed independently, and there were no statistically significant intergroup differences in internalizing symptoms (anxiety, depression) or externalizing symptoms (conduct issues). Conclusions Patients with recurrent presentations for the same complaint had significantly higher rates of overall psychosocial impairment. Regardless of complaint acuity, impairment rates were notable, with 20% of patients reporting internalizing symptoms, such as anxiety and depression. Psychosocial issues should be considered in all pediatric ED patients but particularly those with greater than 3 health care visits for the same presenting complaint.

Effects of a Preventive Parenting Intervention for Divorced Families on the Intergenerational Transmission of Parenting Attitudes in Young Adult Offspring

This study evaluates whether the New Beginnings Program (NBP), a parenting intervention for divorced mothers, led to positive parenting attitudes in young adult offspring. Data were collected from 240 mothers (G1) and offspring (G2) at ages 9-12 and again in adolescence and young adulthood. Alternative theoretical models were tested to examine mediators of NBP effects on G2 parenting attitudes. Significant interactions between condition and baseline G1 parenting indicated that NBP improved G2s parenting attitudes for those exposed to poorer G1 parenting at program entry. Effects on G2 warm attitudes were partially mediated through program effects on G1 warm parenting. The implications of improving parenting attitudes in offspring who experience parental divorce on well-being in the next generation are discussed.