Pediatric psychiatric emergency rooms during COVID-19: a multi-center study.

BACKGROUND: The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS: Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS: There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION: The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.

The Role of Individual Discrimination and Structural Stigma in the Mental Health of Sexual Minority Youth.

OBJECTIVE: Sexual minority (SM) youth experience a greater mental health burden compared with their heterosexual peers. This study aimed to characterize mental health disparities among SM compared with non-SM youth, test main and interactive associations of SM identity and stressors targeting SM youth at the individual level (interpersonal SM discrimination) and structural level (state-level structural SM stigma) with youth mental health, and explore the contribution of interpersonal SM discrimination to the mental health burden of SM youth. METHOD: Participants included 11,622 youth (ages 9-13; 47.6% assigned female at birth) from the Adolescent Brain Cognitive Development (ABCD) Study. Linear mixed-effects models tested main and interactive associations of SM identity, interpersonal SM discrimination, and structural SM stigma with mental health measures (self-reported overall psychopathology, suicidal ideation, and suicide attempts), adjusting for demographics and other interpersonal stressors not specific to SM (other discrimination types, peer victimization, and cyberbullying). Longitudinal mediation models tested whether interpersonal SM discrimination mediated the associations between SM identity and mental health measures. RESULTS: SM youth (n = 1,051) experienced more interpersonal SM discrimination and overall psychopathology compared with their non-SM peers (n = 10,571). Adjusting for demographics, there were significant associations (main effects) of interpersonal SM discrimination and structural SM stigma with overall psychopathology. When further adjusting for other non-SM-related stressors, the main effect of structural SM stigma was no longer significant. Interpersonal SM discrimination was also significantly associated with suicidal ideation and attempt, accounting for demographics, while structural SM stigma was not. Accounting for both demographics and other non-SM stressors, there was a significant interaction between SM identity and structural SM stigma in association with psychopathology (p = .02), such that, compared with their peers, SM youth showed a greater association between structural SM stigma and psychopathology. Longitudinal mediation revealed that interpersonal SM discrimination was a significant mediator explaining approximately 10% to 15% of the variance of the pathways between SM identity and all mental health outcomes. CONCLUSION: Results delineate contributions of interpersonal discrimination and structural stigma targeting SM youth to their heightened mental health burden in early adolescence. These findings underscore the need to address microlevel and macrolevel SM discrimination and structural stigma when caring for this population. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Mental health and timing of gender-related events among transgender and gender-diverse children and adolescents seeking gender-affirming consultation and care.

Transgender and gender-diverse (TGD) youth encounter unique challenges affecting their mental health, largely related to societal stigma and gender dysphoria. Limited research considers the specific needs of TGD youth. This study examined demographic and developmental factors, including the ages at which gender-related events occur, and their relationship to mental health among TGD youth seeking gender-affirming consultation and care (GACC). We examined the medical records of 674 TGD children and adolescents, comparing demographics, gender-related events, and mental health across gender groups. The total sample comprised 261 patients assigned male at birth, and 413 patients assigned female at birth. Non-binary individuals reported higher rates of psychopathology compared to binary transgender patients, with transgender boys exhibiting higher rates than transgender girls. Seeking GACC at a more advanced pubertal stage and older age was associated with an increased likelihood of psychopathology. Later recollection of first gender incongruence memory was correlated with higher rates of depression and anxiety. Finally, socioeconomic status was linked to GACC healthcare-seeking behaviors. These findings underscore the importance of recognizing the diverse experiences and needs of TGD youth seeking GACC services, highlighting that early identification and access to care may be crucial for improving mental health outcomes.

COVID-19 Morbidity Among Individuals with Autistic Spectrum Disorder: A Matched Controlled Population-Based Study.

In this study we aimed to assess whether individuals with ASD are prone to higher infection rates, or to severe COVID-19 illness. Individuals with ASD and age- and gender-matched controlled counterparts (total n = 32,812) were assessed for COVID-19 infection rates and hospitalizations. Results indicated higher infection rates among individuals with ASD, with the largest effect among individuals aged 40-60 (OR = 2.05, 95%CI 1.33-3.15, p < .001), as well as higher odds for hospitalizations, evident primarily in men (OR = 2.40, 95%CI 1.14-5.02, p = 0.02) but not women. Medical and environmental risk factors may associate ASD with higher infection and morbidity rates. Healthcare policy providers should consider proactive steps to protect this population from the associated risks.

Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics.

BACKGROUND: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. METHODS: a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). RESULTS: The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. CONCLUSIONS: The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.

[The untold story--the stories of Ethiopian women].

The immigration of Ethiopian Jews to Israel posed new challenges to their family physicians. The gaps in health beliefs between the Ethiopian immigrants and western medicine culture imposed difficulties on the work of the medical team. Somatization is common among Ethiopian immigrants. In this article the authors present the stories of three Ethiopian women who immigrated to Israel during the last decade. They presented many different complaints, with no medical explanations. Their stories illuminate personal, social and cultural concepts which characterize these women.

Monitoring Attention in ADHD with an Easy-to-Use Electrophysiological Index.

Attention deficit hyperactivity disorder (ADHD) involves characteristic electroencephalographic (EEG) activity. We developed a single-channel EEG marker for attention: the Brain Engagement Index (BEI'). In this study, we evaluated the use of BEI' for distinguishing between ADHD patients and controls, and for monitoring the effect of pharmacological treatment on ADHD patients. The BEI' values of 20 ADHD patients and 10 controls were measured using a 1-min auditory oddball paradigm and a continuous performance test (CPT) task. We showed that CPT BEI' is trait-specific and separates controls from ADHD patients. At the same time, oddball BEI' is state-specific and identifies differences in attention level within the two groups of ADHD participants and controls. The oddball BEI' also associates with response to treatment, after distinguishing between treatment effect and learning/time effect. The combined use of this marker with common computerized tests holds promise for research and clinical use in ADHD. Further work is required to confirm the results of the present study.

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders.

OBJECTIVE: Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. METHOD: We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. RESULTS: The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89-6.14, Axis-II:2.10-10.02; Men, Axis-I:1.92-6.21, Axis-II:1.63-6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. CONCLUSION: The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients.

Bipolar disorder (BD) is characterized by cognitive deficits that impair patients' functioning and quality of life. Most of the earlier studies assessing changes in BD patients' cognitive functioning over time utilized a cross-sectional research design. The few longitudinal studies that were conducted tended to have methodological limitations such as very short follow-up periods, recruitment of acutely ill patients, and lack of assessment of practice effects. The current study aimed to assess changes over time in the cognitive functioning of typical BD outpatients. For this purpose, asymptomatic and mildly symptomatic BD outpatients were assessed at baseline and after two years (n=31). At baseline, the cognitive functioning of the BD patients was compared to that of gender- and age-matched healthy controls. Practice effects were estimated by re-assessing the controls one week after their first assessment. Compared to the controls, BD patients had deficits in psychomotor speed, sustained attention, and one domain of executive functioning (cognitive planning). No evidence was found of a decline in their cognitive functioning over the two year time interval. These findings support a developmental model of cognitive impairment in BD. Studies using longer follow-up periods and larger sample sizes, however, are needed before these conclusions can be stated confidently.