A different kind of battle: the effects of NICU admission on military parent mental health.

OBJECTIVE: To determine the incidence of mental health symptoms in military families after prolonged NICU admission. STUDY DESIGN: Prospective cohort study of military-affiliated NICU parents participating in serial electronic surveys, which included validated screening tools for acute stress (ASD), post-traumatic stress (PTSD), and depression disorders. RESULTS: Among 106 military parents surveyed after NICU admission, 24.5% screened positive for ASD and 28.3% for depression. 77 (72.6%) parents continued participation beyond discharge, with 7.8% screening positive for PTSD and 15.6% for late depression. Positive ASD correlated with later symptoms of PTSD (OR 8.4 [2.4-30]) and early depression with both PTSD symptoms (OR 5.7 [1.7-18.8]) and late depression (OR 8.4 [2.4-30]) after discharge. Secondary analysis determined these findings were independent of deployment and other military related factors. CONCLUSION: This study highlights the potential mental health burden experienced by military-affiliated NICU parents. Early ASD and depression screening may identify parents at risk for mental health symptoms after discharge.

The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use.

OBJECTIVE: Assess the influence of healthcare utilization on previously reported associations between contraception initiation, diagnosis of depression, and dispensing of antidepressant medications. STUDY DESIGN: Retrospective cohort analysis of insurance records from 272,693 women ages 12-34 years old enrolled in the United States Military Healthcare System in September 2014 and followed for 12 months. We compared outcomes of women who initiated hormonal contraception with all women eligible for care and then with women who accessed care during the study month using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Women age 12-34 who initiated hormonal contraception experienced a higher risk of depression diagnosis and antidepressant use when compared to all enrolled women but not when compared to women who accessed care. Among those who accessed care, some progestins (i.e., levonorgestrel, Hazard Ratio (HR) = 1.46, and norelgestromin, HR = 1.93) were associated with an increased rate of depression diagnosis but not antidepressant use; norethindrone (HR = 0.21) was associated with a decreased rate of depression diagnosis. CONCLUSION: When compared to women utilizing their health insurance, associations between initiating hormonal contraception and depression diagnosis and antidepressant use decreased or disappeared. This suggests that healthcare utilization may have confounded previous reports of an association between hormonal contraception use and depression and antidepressant use.

Identifying and Preventing Eating Disorders in Adolescent Patients with Obesity.

Adolescents with obesity are not immune to developing disordered eating and eating disorders. They most commonly present with atypical or subthreshold criterion due to excess body weight or questions regarding the presence of a distorted body image. Patients with premorbid overweight/obesity and subsequent achievement of weight loss may lead to delays in the recognition and treatment of disordered eating and eating disorders. In fact, disordered eating and eating disorders tend to be higher in those undergoing weight management. This article describes risk factors for the development of eating disorders, common features of eating disorders in adolescents with obesity, and provides recommendations for prevention strategies. [Pediatr Ann. 2018;47(6):e232-e237.].