Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study.

BACKGROUND: Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. METHOD: A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms. RESULTS: On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time. CONCLUSIONS: This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.

Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5.

BACKGROUND: Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches. METHODS: Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. RESULTS: Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. CONCLUSIONS: The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.

Taxonomy and utility in the diagnostic classification of mental disorders.

OBJECTIVE: One strategy for improving the clinical utility of mental health diagnostic systems is to better align them with how clinicians conceptualize psychopathology in practice. This approach was used in International Classification of Diseases 11th Revision (ICD-11) development, but its underlying assumption-a link between taxonomic "fit" and clinical utility-remains untested. METHODS: Using data from global mental health clinician samples (combined N = 5404), we investigated the association between taxonomic fit and clinical utility in mental disorder categories. RESULTS: The overall association between fit and utility was positive (r = 0.19) but statistically not different from zero (95% confidence interval [CI]: -0.06, 0.43) in this small sample (N = 39 ICD/DSM categories). However, a positive association became clear after correcting for outliers (r = 0.34 [0.05, 0.58] or higher). Further insights were apparent for specific diagnoses given their locations in the scatterplot. CONCLUSIONS: Results suggest a positive link between taxonomic fit and clinical utility in mental disorder diagnoses, highlighting future research directions.

Historical Analysis: Editors' Reflections on 50 Years of the Journal of Pediatric Psychology.

OBJECTIVE: This article provides an historical perspective on the Journal of Pediatric Psychology (JPP) on the occasion of its 50th anniversary. METHODS: Former and current editors of JPP participated in a symposium at the 2019 Society of Pediatric Psychology Annual Conference (SPPAC), each highlighting prominent types of articles published during their terms, the influence of these papers over time, and their reflections on the next 50 years of the journal. Their presentations were summarized and integrated for this article. Additional data on editorial teams, special issues, and publication metrics over time are included. RESULTS: The data demonstrate changes over time in the growth, scope, and impact of JPP. The article also shows the consistency in areas of emphasis over time. Anticipated topics for the future were quite consistent across editors and included increased use of technology, broader attention to teams and approaches, and methodological advances as the field will continue to grow. CONCLUSIONS: This article provides an unusual collaboration among editors of JPP, providing an historical perspective on the journal's growth over time and anticipation of continued impact into the future.

Historical Analysis: The Journal of Pediatric Psychology From 1976 to 2015.

Objective: To provide a historical analysis through the examination of trends in type of articles, content areas, and population groups across all issues of the Journal of Pediatric Psychology (JPP). Method: All articles published in JPP between the years 1976-2015 were coded based on article type (e.g., original research, meta-analysis), content code (e.g., adherence, primary care), and population code (e.g., oncology, chronic and recurrent pain). Descriptive statistics were calculated. Results: The overall top article types, content codes, and population codes are described as well as top codes for each decade. Overall, the majority of articles were classified as original research. Although some population and content codes varied over time, there were some areas that were consistently present throughout issues, including family systems, cognitive/intellectual functioning, pediatric oncology, and type 1 diabetes. Many topics selected for special issues and topics were consistent with top population and content codes. Conclusions: Findings indicate that most top areas have consistently been present in JPP over the 39-year period. The current historical analysis highlights these patterns as well as serves as a historical record for JPP.

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology.

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

Commentary: The Wright Ross Salk Award: Worker Bees and Benefits to the Hive: Service Contributions to the Profession and Society of Pediatric Psychology.

This article reflects on service contributions upon receiving the 2016 Society of Pediatric Psychology Wright Ross Salk Distinguished Service Award. As the title implies, worker bees make service contributions for the overall benefit of the hive and colony. So too, the scientific discipline, clinical profession, and the Society of Pediatric Psychology need the service contributions of multiple individuals to survive and thrive. Many people have made professional contributions to benefit the field and its organizational home; many more worker bees will volunteer in the future to fill important service roles and sustain the hive. The article discusses lessons learned about service.

Mealtime behaviors associated with consumption of unfamiliar foods by young children with autism spectrum disorder.

Parent and child mealtime behaviors associated with consumption of unfamiliar foods by children with ASD were examined. Families of 38 children aged 2 through 8 years old and diagnosed with ASD videotaped a typical home mealtime during which parents presented the child with an unfamiliar food and mealtime behaviors were subsequently coded through an observational coding system. The child taking sips of their drink was the only behavior related to whether the child took a bite of the unfamiliar food throughout the course of the meal. Parent direct commands and parents feeding the child were related to greater frequency of subsequent bites in a close temporal window, while child play, the child being away from the table, and child talk about things other than food related to lower frequencies of subsequent bites. Clinical interventions for food selectivity in children with ASD might provide parents education on effective mealtime parenting strategies and decreasing inappropriate child mealtime behaviors.

Categories that should be removed from mental disorders classifications: perspectives and rationales of clinicians from eight countries.

OBJECTIVE: To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. METHOD: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. RESULTS: The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. CONCLUSION: Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.

Clinical Validation of a Machine-Learned, Point-of-Care System to IDENTIFY Functionally Significant Coronary Artery Disease.

Many clinical studies have shown wide performance variation in tests to identify coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) has been identified as an effective rule-out test but is not widely available in the USA, particularly so in rural areas. Patients in rural areas are underserved in the healthcare system as compared to urban areas, rendering it a priority population to target with highly accessible diagnostics. We previously developed a machine-learned algorithm to identify the presence of CAD (defined by functional significance) in patients with symptoms without the use of radiation or stress. The algorithm requires 215 s temporally synchronized photoplethysmographic and orthogonal voltage gradient signals acquired at rest. The purpose of the present work is to validate the performance of the algorithm in a frozen state (i.e., no retraining) in a large, blinded dataset from the IDENTIFY trial. IDENTIFY is a multicenter, selectively blinded, non-randomized, prospective, repository study to acquire signals with paired metadata from subjects with symptoms indicative of CAD within seven days prior to either left heart catheterization or CCTA. The algorithm's sensitivity and specificity were validated using a set of unseen patient signals (n = 1816). Pre-specified endpoints were chosen to demonstrate a rule-out performance comparable to CCTA. The ROC-AUC in the validation set was 0.80 (95% CI: 0.78-0.82). This performance was maintained in both male and female subgroups. At the pre-specified cut point, the sensitivity was 0.85 (95% CI: 0.82-0.88), and the specificity was 0.58 (95% CI: 0.54-0.62), passing the pre-specified endpoints. Assuming a 4% disease prevalence, the NPV was 0.99. Algorithm performance is comparable to tertiary center testing using CCTA. Selection of a suitable cut-point results in the same sensitivity and specificity performance in females as in males. Therefore, a medical device embedding this algorithm may address an unmet need for a non-invasive, front-line point-of-care test for CAD (without any radiation or stress), thus offering significant benefits to the patient, physician, and healthcare system.

Relationship between camp attendance and self-perceptions in children with chronic health conditions: a meta-analysis.

OBJECTIVE: A meta-analysis examined the association between camp attendance and changes in self-perceptions in children with chronic health conditions. METHODS: Studies using quantitative methods to assess changes in self-perceptions while attending camps designed for children with chronic health conditions were included in analyses. A random-effects model was used, and Cohen's d was used to calculate effect sizes at both post-camp and follow-up. Some potential moderators of effects were examined (i.e., type of measure of self-perceptions, children's chronic health condition, camp components). RESULTS: 31 studies were included in the analyses. Children experienced small, but statistically significant, improvements in self-perceptions at both post-camp (d = .25, 95% CI [.16-.34]) and extended follow-up (d = .15, 95% CI [.05-.26]). This relationship was moderated by type of measure of self-perceptions and child health condition. CONCLUSIONS: Camp attendance is associated with small improvements in self-perceptions for children with some chronic health conditions.

Mental health professionals' natural taxonomies of mental disorders: implications for the clinical utility of the ICD-11 and the DSM-5.

OBJECTIVE: To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11). METHOD: 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. RESULTS: Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals. CONCLUSIONS: The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.

Psychologists' perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey.

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.

Case-controlled field study of the ICD-11 clinical descriptions and diagnostic requirements for Bodily Distress Disorders.

AIMS: Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study compared the accuracy of clinicians' diagnosis of disorders of somatic symptoms using either the ICD-11 or ICD-10 diagnostic guidelines in an online study. METHODS: Clinically active members of the World Health Organization's Global Clinical Practice Network (N = 1065) participating in English, Spanish, or Japanese were randomly assigned to apply ICD-11 or ICD-10 diagnostic guidelines to one of nine pairs of standardized case vignettes. The accuracy of the clinicians' diagnoses as well as their ratings of the guidelines' clinical utility were assessed. RESULTS: Overall, clinicians were more accurate using ICD-11 compared to ICD-10 for every presentation of a vignette characterized primarily by bodily symptoms associated with distress and impairment. Clinicians who made a diagnosis of BDD using ICD-11 were generally correct in applying the severity specifiers for the condition. LIMITATIONS: This sample may represent some self-selection bias and thus may not generalize to all clinicians. Additionally, diagnostic decisions with live patients may lead to different results. CONCLUSIONS: The ICD-11 diagnostic guidelines for BDD represent an improvement over those for Somatoform Disorders in ICD-10 in regard to clinicians' diagnostic accuracy and perceived clinical utility.

A systematic and quantitative review of interventions to facilitate school reentry for children with chronic health conditions.

OBJECTIVE: To conduct as systematic and quantitative review of research on the effects of school reentry interventions for children with chronic health conditions. METHODS: This analysis examined 2 primary outcomes: increasing illness- or injury-specific knowledge among teachers or healthy peers and enhancing positive attitudinal change toward an ill or injured child. A secondary analysis examined any change in the ill or injured child's global self-worth following the intervention. A random-effects model was used in all analyses, and effect sizes were analyzed using heterogeneity tests. RESULTS: Larger effect sizes were found for increases in knowledge than for enhancing positive attitudinal changes (i.e., mean ES for knowledge: 0.84-0.88; mean ES for positive attitudinal change: 0.68), and larger effect sizes were found for teachers than for healthy peers in both analyses. Significant heterogeneity was found between groups (i.e., teachers vs. healthy peers) and within groups in both analyses. Results of the secondary analysis indicated a medium effect for improvements in global self-worth (i.e., mean ES = 0.24). CONCLUSIONS: This analysis provides support for the effectiveness of school reentry interventions and highlights the critical need for more empirical work in this area.

Six degrees of separation: an exploratory network analysis of mentoring relationships in pediatric psychology.

OBJECTIVE: The present study is an exploratory social network analysis of mentee-mentor relationships in the field of pediatric psychology. METHOD: An online survey was distributed to members of the Division 54 Society of Pediatric Psychology (SPP) listserv asking them to name up to 10 psychologists from whom they had "received mentoring" and who influenced their careers. Directed network analyses were conducted to examine features of the resulting mentoring network. RESULTS: Participants reported receiving mentoring in a wide variety of relationships and settings. The average "degrees of separation" between individuals in the network was 5.30. CONCLUSION: : The field of pediatric psychology is interconnected with professionals learning from multiple mentors in multiple settings, extending beyond just graduate student advisors. Overall, many different mentors were listed, and there does not appear to be only one or two individuals providing the majority of mentoring within the field.

Perceived benefits of mentoring in pediatric psychology: a qualitative approach.

OBJECTIVE: To identify tangible and intangible benefits of mentoring cited by a select group of identified mentors. METHODS: Twenty frequently named mentors within pediatric psychology provided responses to open-ended questions regarding benefits they have experienced through the mentoring process. RESULTS: Mentors identified many personal and professional benefits of the mentoring relationship, although they did not clearly distinguish between tangible and intangible advantages to the relationship. The most commonly reported benefits included career development of the mentee, mentor's career enhancement, and a sense of giving back to the field of pediatric psychology. CONCLUSIONS: A bidirectional definition of mentoring more accurately describes the relationship than a more traditional unidirectional definition. These results suggest that mentors experience a wide variety of benefits that could be examined more closely within the field.

A global clinicians' map of mental disorders to improve ICD-11: analysing meta-structure to enhance clinical utility.

Enhancing clinical utility is an emphasis of the World Health Organization's development of the mental and behavioural disorders chapter of the next International Classification of Diseases (ICD-11). Understanding how clinicians conceptualize the structure of mental disorders can enable a more clinically intuitive classification architecture that will help professionals find the categories they need more efficiently. This study examined clinicians' conceptualizations of the relationships among mental disorders and the dimensions they use in making these judgements. Psychiatrists and psychologists from 64 countries (n = 1,371), participating in English or Spanish, rated the similarity of mental and behavioural disorders presented as paired comparisons. Data were analysed by multidimensional scaling procedures (INDSCAL) and by analyses of consistency. Participants used three distinctive dimensions to evaluate the similarity among disorders: internalizing versus externalizing, developmental versus adult onset, and functional versus organic. Clinicians' conceptual map of mental disorders was rational and highly stable across profession, language, and country income level. The proposed ICD-11 structure is a moderately better fit with clinicians' conceptual model than either ICD-10 or DSM-IV. Clinician judgements can be used to improve clinical utility of the ICD-11 without sacrificing validity based on a scientific approach to enhancing a logically organized classification meta-structure.

Predictors of Dissertation Publication in Clinical and Counseling Psychology.

A doctoral dissertation constitutes a student's original research and a novel contribution to scientific knowledge. Yet, few psychology dissertations, particularly in professional subfields, are published in the peer-reviewed literature, and the reasons for this are unclear. The present study investigated student, advisor, and doctoral program variables that might predict dissertation publication in professional psychology. Using a stratified random cohort sample of 169 Ph.D. dissertations in clinical and counseling psychology, we conducted exhaustive searches to determine whether dissertation studies were published in peer-reviewed journals within 0-7 years following their completion. Logistic regression models were estimated to test whether dissertation publication was predicted by student and advisor prior research productivity, dissertation length, and doctoral program's training emphasis, accreditation status, and subfield. Results indicated that dissertations that were supervised by more research-productive advisors and that were relatively brief (<180 pages) were significantly more likely to be published in peer-reviewed journals. No other predictors were significant. Results are discussed with regard to implications for training and mentorship. Faculty advisors who publish frequently might be more likely to attract research-oriented students, to mentor students in preparing a publishable dissertation, and/or to encourage students to publish their dissertation research. By systematically promoting research dissemination as part of doctoral research training, graduate programs and faculty mentors in clinical and counseling psychology could help facilitate students' sharing their dissertation findings with the scientific community.

An international survey examining the impact of the COVID-19 pandemic on telehealth use among mental health professionals.

BACKGROUND: COVID-19 has profoundly affected the work of mental health professionals with many transitioning to telehealth to comply with public health measures. This large international study examined the impact of the pandemic on mental health clinicians' telehealth use. METHODS: This survey study was conducted with mental health professionals, primarily psychiatrists and psychologists, registered with WHO's Global Clinical Practice Network (GCPN). 1206 clinicians from 100 countries completed the telehealth section of the online survey in one of six languages between June 4 and July 7, 2020. Participants were asked about their use, training (i.e., aspects of telehealth addressed), perceptions, and concerns. OUTCOMES: Since the pandemic onset, 1092 (90.5%) clinicians reported to have started or increased their telehealth services. Telephone and videoconferencing were the most common modalities. 592 (49.1%) participants indicated that they had not received any training. Clinicians with no training or training that only addressed a single aspect of telehealth practice were more likely to perceive their services as somewhat ineffective than those with training that addressed two or more aspects. Most clinicians indicated positive perceptions of effectiveness and patient satisfaction. Quality of care compared to in-person services and technical issues were the most common concerns. Findings varied by WHO region, country income level, and profession. INTERPRETATION: Findings suggest a global practice change with providers perceiving telehealth as a viable option for mental health care. Increasing local training opportunities and efforts to address clinical and technological concerns is important for meeting ongoing demands.