Prevalence of Psychiatric Disorders Among Children and Adolescents in Child Welfare Custody Admitted to the Hospital: A Nationwide Inpatient Sample Analysis.

Objective: To assess the prevalence of psychiatric disorders among children and adolescents in child welfare custody admitted to the hospital.Methods: Data were collected from the 2016-2017 National Inpatient Sample of the US population of general hospital admissions. Data for patients aged 12-17 years who were in child welfare custody were obtained using the ICD-10 diagnosis code Z6221: child in welfare custody. The control group comprised patients not in child welfare custody. Groups were compared for demographic, clinical, and hospital characteristics.Results: The study group included 879 child welfare patients, of whom 38.9% were male, with a mean age of 14.7 years. The control group comprised 222,494 patients, of whom 41.2% were male, with a mean age of 14.9 years. In the study group, 69.4% of patients had mood disorders compared to 28.6% in the control group. Half of the patients in the study group had anxiety disorders and almost 44% had ADHD and other conduct disorders compared to 19.3% and 14.2%, respectively, in the control group. Prevalence of suicidal ideation/attempt was almost 3 times higher in the study group compared to controls (41.0% vs 14.8%), and 18.3% of study group patients had a substance use disorder compared to 8.3% of controls. Mood disorders were the most common reason for hospitalization (44.8% vs 19.2%), followed by ADHD/other conduct disorders (5.3% vs 1.1%) and anxiety disorders (4.9% vs 0.9%).Conclusions: Children and adolescents in the child welfare system are associated with a higher risk of mental health problems. More studies are needed to identify the factors that contribute to psychiatric comorbidities in this population and to determine and address the factors that can prevent mental health issues.Prim Care Companion CNS Disord 2023;25(6):22m03238. Author affiliations are listed at the end of this article.

Sex Differences in Psychiatric Comorbidities in Adolescents With Autism Spectrum Disorder: A National Inpatient Sample Analysis.

Objective: To investigate sex differences in psychiatric comorbidities in adolescents with autism spectrum disorder (ASD).Methods: The US National Inpatient Sample dataset (January 2016 to December 2018) was used for this retrospective study. The patient population was selected by performing a query on all adolescent patients (aged 12-17 years) having ASD with the ICD-10-CM code starting with F84. All missing sex data were excluded. Additional data on mood disorders, anxiety disorders, personality disorders, adjustment disorders, psychotic disorders, attention-deficit/hyperactivity disorder (ADHD)/conduct disorders, sleep-wake disorders, and substance use disorders were collected. Data on psychiatric comorbidities were collected using the ICD-10-CM code provided in the Clinical Classifications Software of the dataset.Results: Mood disorders (37.4% vs 44.1%, P < .001) and anxiety disorders (29.4% vs 37.0%, P < .001) were more prevalent in females compared to males. The prevalence of ADHD and other conduct disorders was significantly higher in males than females (47.7% vs 36.7%, P < .001). Substance use disorders were slightly higher among males compared to females (3.7% vs 3.0%, P = .04).Conclusion: The study findings revealed statistically significant disparities in psychiatric comorbidities among adolescent male and female patients with ASD. These findings could serve as a pilot for larger-scale research with this patient population in the future.

The Association of Psychological Stressors With Cannabis Use During Pregnancy: Findings From the National Survey on Drug Use and Health 2017-2019.

ABSTRACT: Even though marijuana is illegal on the federal level, it is one of the most used drugs in the United States during pregnancy. Our study investigates the relationship between numerous socioeconomic, demographic, and mental health risk variables and substance use during pregnancy. We examined data from the National Survey on Drug Use and Health from 2017 to 2019. Compared with the no serious psychological distress (SPD) group, the odds of using cannabis were higher in pregnant women with past-month SPD. In this study, in comparison with unmarried pregnant women, married pregnant women had a 67% lower chance of currently using cannabis. Racially, Hispanic pregnant women had 3 to 4 times higher odds for current use of cannabis as compared with the other races. Preventing cannabis use and its adverse effects by screening pregnant women could be part of the current strategy for reducing cannabis use.

What to Expect When Switching to a Second Antidepressant Medication Following an Ineffective Initial SSRI: A Report From the Randomized Clinical STAR*D Study.

OBJECTIVE: An antidepressant medication switch often follows a failed initial trial with selective serotonin reuptake inhibitors (SSRIs). When, for whom, and how often second-step response and remission occur are unclear, as is preferred second-step trial duration. As more treatments are approved for use following 2 failed "adequate" trials, researchers and clinicians require an evidence-based definition of "adequate." METHODS: Following citalopram in the randomized Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial (which ran July 2001-September 2006), participants with score ≥ 11 on the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR16) were randomized to bupropion sustained release, sertraline, or venlafaxine extended release (up to 14 weeks). The QIDS-SR16 defined response, remission, and no clinically meaningful benefit based on the modified intent-to-treat sample. RESULTS: About 80% of 438 participants completed ≥ 6 weeks of treatment with the switch medication. All treatments had comparable outcomes. Overall, 21% (91/438) remitted, 9% (40/438) responded without remission, and 58% (255/438) had no meaningful benefit. Half of the responses and two-thirds of remissions occurred after 6 weeks of treatment. Overall, 33% of responses (43/131) occurred after ≥ 9 weeks of treatment. No baseline features differentiated early from later responders or remitters. No early triage point was found, but those with at least 20% reduction from baseline in QIDS-SR16 score around week 2 were 6 times more likely to respond or remit than those without this reduction. CONCLUSIONS: Following nonefficacy with an initial SSRI, only about 20% remit and more than half achieve no meaningful benefit with a second-step switch to another monoaminergic antidepressant. A 12-week trial duration seems necessary to capture as many second-step switch responders as possible. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00021528.

Electroconvulsive Treatment Utilization for the Inpatient Management of Severe Manic Episodes of Bipolar Disorder.

OBJECTIVE: Main objectives of the study are to (1) describe the utilization of electroconvulsive treatment (ECT) for the treatment of manic episodes (ME) and (2) examine the effect of early inpatient use of ECT (within 7 days of admission) compared with delayed use on length of stay and cost of inpatient care. METHOD: The total sample of 14,005 inpatients with a principal diagnosis of bipolar disorder, ME (2012-2014), from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project were analyzed using univariate and logistic regressions. This represented data from 4411 hospitals from 45 states in the United States. RESULTS: The rate of ECT use was higher in young adults (<50 years), female patients, and whites from high-income families. Electroconvulsive treatment was preferred more in private, nonprofit, urban, and teaching hospitals. The percentages of overall hospitals where ECT was administered for mania by region were as follows: 22% in the Northeast, 23% in Midwest. 17% in the South, and 10% in the West. Approximately half (55.3%) of patients received initial ECT session within the first 7 days (median) after admission. Early ECT was associated with significantly shorter (-14.7 days) and less costly (-$41,976) inpatient care per patient. CONCLUSIONS: Patients treated with ECT are generally sicker and more treatment resistant. However, ECT should not be considered only as a "last resort" in the treatment algorithm. Inpatient ECT for patients with MEs if initiated during the first 7 days of hospitalization reduces length of stay and cost.