Early Identification of Barriers and Facilitators to Self-Management Behaviors in Pediatric Patients With Sickle Cell Disease to Minimize Hematopoietic Cell Transplantation Complications.

Hematopoietic cell transplantation (HCT) is an elective, curative treatment option for patients with sickle cell disease (SCD). Transplant requires extensive self-management behaviors to be successful. The purpose of this study was to describe potential barriers and facilitators to self-management in a group of pediatric patients with SCD prior to HCT and their medical outcomes post-HCT. A multiple case study approach was used to describe 4 pairs of transplant recipients grouped by age, donor type, and donor source. Each pair included a case with minimal and increased post-HCT complications. Complications included readmissions, graft-versus-host disease, systemic infections, and survival in the first year post-HCT. Variables were retrospectively collected and content analyzed to identify barriers and facilitators within and across pairs using existing self-management frameworks. While higher risk transplants experienced more complications, 3 of the 4 cases with increased complications had a larger number of modifiable barriers identified compared with those experiencing minimal complications. At least one modifiable barrier and multiple facilitators were identified in all cases. A standardized psychosocial assessment process with an established plan to mitigate barriers and promote facilitators to self-management is essential to optimize outcomes in patients with SCD undergoing elective HCT.

Depression as a mediator in the relationship between perceived familial criticism and college adaptation.

OBJECTIVE: This study examined relationships among emerging adults' perceived familial criticism, their depressive symptoms, and their college adaptation. PARTICIPANTS: The current study examined the responses of 412 emerging adults (300 females and 112 males) who were college students at a large southeastern university. The majority of these emerging adults were Caucasian, but the remainder were from a broad range of racial backgrounds. METHODS: Participants completed the Family Emotional Involvement and Criticism Scale as a measure of their familial criticism, the Student Adaptation to College Questionnaire as a measure of their college adaptation, and the Beck Depression Inventory-Second Edition as a measure of their depression. RESULTS: Results were examined using correlational and regression analyses in the context of Baron and Kenny's (J Pers Soc Psychol. 1986;51:1173-1182) method for determining mediation. Results suggested that for female emerging adults, the relationship between perceived familial criticism and college adaptation was mediated significantly by depressive symptoms. In contrast, this pattern of results did not hold for male emerging adults. CONCLUSIONS: Given these findings, emerging adults' depressive symptoms may serve as a useful proximal target for psychotherapeutic interventions meant to improve adaptation to college (particularly for female emerging adults), even in the context of high levels of perceived familial criticism from emerging adults' family of origin.

Bipolar disorder in children.

Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.