Structural Inequities and the Impact of COVID-19 on Latinx Children: Implications for Child and Adolescent Mental Health Practice.

In the United States, the Latinx community (Latinx is a gender-neutral term to describe any person of Latin American descent or heritage) is a heterogeneous population with diverse cultural origins, different migratory experiences, and different socioeconomic and educational realities. The disruptions to daily life and the associated stresses of the 2019 novel coronavirus disease (COVID-19) pandemic have been perhaps most acutely felt by Black and Latinx children from low-income families, including first-generation and undocumented immigrants.1 Structural inequities, such as the lack of employer-sponsored insurance in the service and retail industries; barriers to applying for public benefits, even for those who qualify; chronic poverty; and the lack of linguistically and culturally effective services have contributed to the disproportionate impact. In this article, the authors consider how structural inequities have rendered Latinx children particularly vulnerable to the devastating physical and psychological effects of the pandemic, identify risk and protective factors that are related to mental health outcomes, and recommend ways in which child and adolescent psychiatrists can respond to the escalating needs.

Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.

OBJECTIVE: To evaluate a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices serving patient populations of predominantly low-income Latino immigrants. METHODS: In seven practices, academic detailing and consultation/liaison psychiatry were first implemented (Stage 1) and then supplemented with appointment scheduling and reminders to primary care physicians (PCPs) by clinic staff (Stage 2). Acceptability and feasibility were assessed with independent patient samples during each stage. RESULTS: Participating PCP found the interventions acceptable and noted that referrals to language-matched specialty care and case-by-case consultation on medication management were particularly beneficial. The academic detailing and consultation/liaison intervention (Stage 1) did not significantly affect PCP screening, management or patient satisfaction with care. When support for appointment scheduling and reminders (Stage 2) was added, however, PCP referral to psychiatric services increased (P=.04), and referred patients were significantly more likely to follow through and have more visits to mental health professionals (P=.04). CONCLUSION: Improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.

Impact of motivational pharmacotherapy on treatment retention among depressed Latinos.

Compared to non-Latino Whites, U.S. racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed motivational pharmacotherapy, a novel approach that combines motivational interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of motivational pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among n = 50 first-generation Latino outpatients with major depressive disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients' symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational pharmacotherapy appears to improve Latino retention in antidepressant therapy and should be investigated further in controlled designs.

Citalopram treatment of social anxiety disorder with comorbid major depression.

Treatment of patients with both social anxiety disorder and major depression has been little studied although social anxiety disorder and depression frequently co-occur. Each disorder has been shown to respond to serotonin reuptake inhibitor treatment. Objectives of this study were to characterize a sample of these comorbid patients and to assess response to treatment with citalopram. Patients with primary DSM-IV generalized subtype of social anxiety disorder and comorbid major depression (N = 21) were assessed for symptoms of each disorder, including atypical depressive features, and functional impairment. Patients were treated with a flexible dose of open label citalopram for 12 weeks. Response rates for the intention-to-treat sample at week 12 were 14/21 (66.7%) for social anxiety disorder and 16/21 (76.2%) for depression. All continuous measures of social anxiety, depression, and functional impairment improved significantly with treatment, but depression symptoms responded more rapidly and more completely than social anxiety symptoms. Mean dose of citalopram at study endpoint was 37.6 mg/day. Only three patients (14.3%) fulfilled DSM-IV criteria for atypical features of depression, although 18 (85.7%) fulfilled the criterion for interpersonal rejection sensitivity. Citalopram treatment may benefit patients with primary social anxiety disorder and comorbid major depression, and it should be further studied in controlled trials. Improvement in social anxiety disorder symptoms lagged behind improvement in depression, and greater than 12 weeks of treatment may be required to assess full social anxiety response in patients with comorbid depression. The overlap of social anxiety disorder with atypical features of depression may primarily be due to the shared feature of rejection sensitivity.

Intentos suicidas en adolescentes / Attempted suicide in adolescents

Los autores estudiaron los intentos suicidas en adolescentes de 13 a 18 años. Fueron 41 casos de los 203 adolescentes atendidos en 18 meses en la Clínica de Salud Mental del Hospital Pediátrico Universitario. Esto constituyó el 20% de los adolescentes. Se estudiaron las variables edad, sexo o escolaridad, religión, número de intentos, sintomatología, metodología, motivación, composición familiar, posición ordinal, e historial de enfermedad mental en la familia, stresses de vida. Entre los hallazgos más importantes los adolescentes del sexo femenino intentan más que los varones. La sintomatología más frecuente se manifiestan con los problemas relacionados con el afecto. La metodología más usada fueron los medicamentos y las motivaciones detrás de los intentos fueron problemas con los padres. Un alto por ciento de estos intentos fue solo, planificado y no avisado. Los estressores de vida de estos adolescentes fluctuaron entre moderados y severos