Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network.

OBJECTIVE: Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM-5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter-rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample. METHOD: We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8-18 years) to 19 Boston-area pediatric gastroenterology clinics for evidence of DSM-5 ARFID. RESULTS: We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding (n = 19) or limited diet due to sensory features of the food (n = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems. DISCUSSION: In a pediatric treatment-seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over-inclusive even in a population where eating/feeding difficulties are expected.

Making an MPCT: Building and Sustaining a Multicultural Psychology Consultation Team (MPCT) Within an Academic Medical Center.

ABSTRACT: The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprecedented commitment from US hospital systems and treatment settings to address health disparities by increasing access to care for historically oppressed and underserved communities. However, the inability of hospital systems to actually provide multiculturally responsive care and, more broadly, to consistently practice cultural humility will only exacerbate patient distrust and the deleterious health and social outcomes we seek to mitigate. This perspective article describes the development of a multidisciplinary team of mental health providers committed to delivering culturally responsive mental health treatment while promoting inclusive workplace environments. We outline the Multicultural Psychology Consultation Team's (MPCT) origin, design, process, and structure and discuss successes and challenges in maintaining the model in its first two years. We recommend that systemic infusion of cultural humility, multiculturally responsive clinical care, and support for providers delivering care be prioritized in concert with efforts to increase access to care for diverse patients. We offer MPCT as a model for supporting these aims.

Factor structure of the counseling center assessment of psychological symptoms (CCAPS): Comparisons across college students in inpatient and outpatient settings.

This study examined the measurement model of the Counseling Center Assessment of Psychological Symptoms 34-item version (CCAPS-34) in 363 college student patients of a psychiatric hospital, and compared their ratings with national student samples treated in counseling centers (the national average). The 7-factor model of the CCAPS-34 fits well with data from patient samples. The measure showed measurement invariance across levels of care (i.e., inpatient and outpatient). Compared to the national average, the most apparent differences in clinical characteristics of hospitalized students were higher levels of depression.

Clinical profiles of college student patients in a psychiatric hospital.

College students represent a significant portion of patients in a psychiatric hospital. However, limited previous research has examined the clinical profiles of this unique population, especially across both inpatient and outpatient settings. To better understand college student mental health, the current study explored the potentially heterogeneous groups of students admitted to inpatient or treated in outpatient units in a large psychiatric hospital. Latent profile analysis (LPA) was used to identify latent clusters based on mental health-related struggles, measured by the Counseling Center Assessment of Psychological Symptoms-34, a measure specifically designed to assess college students. LPA results identified five underlying clusters: 1) negative affect (NA); 2) NA/alcohol struggles; 3) NA/eating concerns; 4) general distress; and 5) low clinical scores. Students who reported comorbid alcohol-related struggles or eating concerns with negative affect showed the greatest overall distress. The NA/alcohol struggles group was more likely to be inpatient than outpatient. Notably, the NA/eating concerns group, one of the most distressed groups, did not significantly predict higher levels of care, indicating that outpatient students may struggle as greatly as inpatient students. The current study provides new insights into the clinical profiles of the important, yet traditionally understudied, population of college students in both inpatient and outpatient psychiatric hospital settings. Future research on college student patients is imperative to better understand college student mental health from both hospital and university perspectives.