Trajectories and correlates of mental health among urban, school-age children during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: The COVID-19 pandemic posed numerous obstacles to psychosocial wellbeing for children. We conducted a longitudinal study to evaluate child mental health and social risks during the pandemic. METHODS: Participants were 172 caregivers of children aged 6-11 years old who attended well child visits within 6 months before pandemic onset at an urban safety net hospital in the US. Prepandemic data was extracted from the electronic medical record, and surveys were administered at three time points between August 2020 and July 2021. We measured mental health symptoms with the Pediatric Symptom Checklist-17, social risks (e.g., food and housing insecurity) with the THRIVE questionnaire, and school modality (in-person, hybrid, remote). RESULTS: Compared to pre-pandemic, children had significantly higher PSC-17 total scores (overall mental health symptoms) and THRIVE total scores (total burden of social risks) at all three mid-pandemic waves. Using longitudinal mixed models accounting for time, social risks, and school modality, both social risks (B = 0.37, SE = 0.14, p < 0.01) and school modality were significantly associated with PSC-17 scores (B = - 1.95, SE = 0.63, p < 0.01). Children attending in-person school had fewer mental health symptoms than those attending remote or hybrid school. CONCLUSION: Mental health symptoms and social risks remained significantly higher fifteen months after the onset of the COVID-19 pandemic compared to prepandemic. In-person attendance at school appeared protective against persistently elevated mental health symptoms.

A Systematic Review of using Virtual and Augmented Reality for the Diagnosis and Treatment of Psychotic Disorders.

Objective: Immersive virtual reality (VR) and augmented reality (AR) have the potential to improve the treatment and diagnosis of individuals experiencing psychosis. Although commonly used in creative industries, emerging evidence reveals that VR is a valuable tool to potentially improve clinical outcomes, including medication adherence, motivation, and rehabilitation. However, the efficacy and future directions of this novel intervention require further study. The aim of this review is to search for evidence of efficacy in enhancing existing psychosis treatment and diagnosis with AR/VR. Methods: 2069 studies involving AR/VR as a diagnostic and treatment option were reviewed via PRISMA guidelines in five databases: PubMed, PsychInfo, Embase, and CINAHL. Results: Of the initial 2069 articles, 23 original articles were eligible for inclusion. One study applied VR to the diagnosis of schizophrenia. Most studies demonstrated that the addition of VR therapies and rehabilitation methods to treatment-as-usual (medication, psychotherapy, social skills training) was more effective than traditional methods alone in treating psychosis disorders. Studies also support the feasibility, safety, and acceptability of VR to patients. No articles using AR as a diagnostic or treatment option were found. Conclusions: VR is efficacious in diagnosing and treating individuals experiencing psychosis and is a valuable augmentation of evidence-based treatments. Supplementary Information: The online version contains supplementary material available at 10.1007/s40501-023-00287-5.

The Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the Kids FACE FEARS sample.

There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in children and adolescents. Despite increased use of the PROMIS, no study has evaluated performance of its anxiety scales in a sample of treatment-engaged anxious youth. Analyses were conducted on baseline data from the first 265 families (child MAge=11.14 years, 70% racial/ethnic minoritized youth) to enroll in the Kids FACE FEARS trial, a multisite comparative effectiveness trial of therapist-led vs. self-administered treatment for elevated youth anxiety. Confirmatory factor analysis (CFA) examined factor structure; omega coefficients and regression models examined internal consistency, convergent validity, and cross-informant reliability. CFA supported adjusted single-factor solutions across youth and caregiver reports, and internal consistency was high. Convergent validity was supported by medium-to-large associations with anxiety-related impairment and severity. Moderate cross-informant reliability between reports was found. Results showcase the first psychometric study of the PROMIS Anxiety scale short forms among treatment-engaged youth with elevated anxiety. Findings highlight the PROMIS Anxiety scale's utility in typical care settings for youth anxiety.

Changes in psychosocial functioning among urban, school-age children during the COVID-19 pandemic.

BACKGROUND: There is concern about the effect of the COVID-19 pandemic on psychosocial functioning among school-age children, who have faced unusual stressors during this time. Our goal was to assess mental health symptoms and social risks during COVID-19, compared to before the pandemic, for urban, racial and ethnic minority school-age children, and investigate the relationship between mental health and social risks. METHODS: We conducted a cohort study from September 2019 until January 2021 of children age 5-11 years old recruited from an urban safety net hospital-based pediatric primary care practice. We measured emotional and behavioral symptoms (including attention, internalizing, and externalizing symptoms) before and during the pandemic with the Pediatric Symptom Checklist (PSC-17). We measured social risks (including food and housing insecurity) before and during the pandemic with the THRIVE screener. We measured additional mid-pandemic COVID-related stressors with items on school participation, screens/media use, illness exposure, and caregiver mental health. We compared pre- and mid-pandemic PSC-17 symptom scores across 4 domains (total, attention, internalizing, and externalizing) and used path analysis to examine the relationship between mental health and social risks pre- and mid-pandemic. RESULTS: Caregivers of 168 children (54% non-Hispanic Black, 29% Hispanic, and 22% non-English speaking) completed the study. Children had significantly higher levels of emotional and behavioral symptoms midpandemic- vs. pre-pandemic in all domains. Significantly more children had a positive PSC-17 total score (18% vs. 8%, p < 0.01) and internalizing (depression and anxiety) score (18% vs. 5%, p < 0.001) during the pandemic vs. before, indicating clinical concerns in these areas. Caregivers reported significantly more social risks during vs. before the pandemic (p < 0.001). Mental health symptoms significantly correlated with number of social risks before the pandemic, but not during the pandemic. Less school assignment completion, increased screen time, and caregiver depression were all significantly associated with worse mid-pandemic mental health in children. CONCLUSION: The COVID-19 pandemic has led to a dramatic increase in depression/anxiety problems and social risks among urban, racial and ethnic minority school-age children compared to before the pandemic. More research is needed to understand if these changes will persist.

Six Stages of Engagement in ADHD Treatment Described by Diverse, Urban Parents.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care. METHODS: We conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis. RESULTS: Of children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child's ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages. CONCLUSIONS: The 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment.

A Meta-analysis of Cognitive Remediation for Schizophrenia: Efficacy and the Role of Participant and Treatment Factors.

The number of randomized, controlled studies of cognitive remediation (CR) for schizophrenia, a therapeutic approach designed to improve cognitive skills and function, has grown substantially over the past 20 years. Active elements of CR treatment, however, remain unknown. The current meta-analysis investigated treatment, study, and participant factors in the size of observed treatment effects. Electronic databases were searched up to May 2020 using variants of the key words "cognitive remediation," "clinical trials," and "schizophrenia." This search produced 73 unique, randomized, controlled trials. Data were independently extracted by 3 reviewers with excellent reliability. Random-effects models were used to assess primary cognitive and secondary symptom and functional outcomes. Moderator analyses investigated the role of a variety of treatment, study, and participant factors. The meta-analysis (4594 participants) revealed that CR produced significant small-to-moderate size improvements in all domains of cognition studied (Hedge's gs = .19-.33). and a significant small improvement in function (Hedge's g = .21). CR programs that included a discussion ("bridging") group to help apply acquired cognitive skills to everyday life produced larger effects on global cognition and verbal memory. CR programs with strategy-coaching produced larger effects on episodic memory. Sample age, gender, positive, negative, and overall symptoms, and medication dose did not serve as barriers to treatment gains. CR produces small-to-moderate improvements in cognition and function in schizophrenia. Programs of CR that utilize bridging groups and strategy-coaching are more cognitively potent. Future research should focus on ways to modify CR to bolster generalization of cognitive improvements to function.