Meeting the service needs of youth with and without a self-reported mental health diagnosis during COVID-19.

Background: The COVID-19 pandemic catalyzed major changes in how youth mental health (MH) services are delivered. Understanding youth's MH, awareness and use of services since the pandemic, and differences between youth with and without a MH diagnosis, can help us optimize MH services during the pandemic and beyond. Objectives: We investigated youth's MH and service use one year into the pandemic and explored differences between those with and without a self-reported MH diagnosis. Methods: In February 2021, we administered a web-based survey to youth, 12-25 years, in Ontario. Data from 1373 out of 1497 (91.72%) participants were analyzed. We assessed differences in MH and service use between those with (N=623, 45.38%) and without (N=750, 54.62%) a self-reported MH diagnosis. Logistic regressions were used to explore MH diagnosis as a predictor of service use while controlling for confounders. Results: 86.73% of participants reported worse MH since COVID-19, with no between-group differences. Participants with a MH diagnosis had higher rates of MH problems, service awareness and use, compared to those without a diagnosis. MH diagnosis was the strongest predictor of service use. Gender and affordability of basic needs also independently predicted use of distinct services. Conclusion: Various services are required to mitigate the negative effects of the pandemic on youth MH and meet their service needs. Whether youth have a MH diagnosis may be important to understanding what services they are aware of and use. Sustaining pandemic-related service changes require increasing youth's awareness of digital interventions and overcoming other barriers to care.

Contexte: La pandémie de la COVID-19 a catalysé des changements majeurs de la manière dont les services de santé mentale (SM) sont dispensés aux jeunes. Comprendre la SM des jeunes, la connaissance et l'utilisation des services depuis la pandémie, et les différences entre les jeunes avec et sans un diagnostic de SM peut nous aider à optimiser les services de SM durant la pandémie et au-delà. Objectifs: Nous avons investigué la SM et l'utilisation des services des jeunes un an après le début de la pandémie et exploré les différences entre ceux avec et sans un diagnostic de SM auto-rapporté. Méthodes: En février 2021, nous avons administré un sondage en ligne à des jeunes de 12 à 25 ans en Ontario. Les données de 1373 participants sur 1497 (91,72 %) participants ont été analysées. Nous avons évalué les différences de SM et d'utilisation des services entre ceux avec (N = 623, 45,38 %) et sans (N = 750, 54,62 %) un diagnostic de SM auto-rapporté. Les régressions logistiques ont servi à explorer le diagnostic de SM comme prédicteur de l'utilisation de services tout en contrôlant les confusions. Résultats: 86,73 % des participants ont rapporté une SM pire depuis la COVID-19, sans différences entre les groupes. Les participants ayant un diagnostic de SM avaient des taux plus élevés de problèmes de SM, de connaissance et d'utilisation des services comparé à ceux sans diagnostic. Le diagnostic de SM était le prédicteur le plus fort de l'utilisation de services. Le sexe et l'abordabilité des besoins de base prédisaient aussi indépendamment l'utilisation de services distincts. Conclusion: Divers services sont nécessaires pour atténuer les effets négatifs de la pandémie sur la SM des jeunes et répondre à leurs besoins de service. Savoir si les jeunes ont un diagnostic de SM peut être important pour comprendre quels services ils connaissent et utilisent. Soutenir les changements de services liés à la pandémie exige d'accroître la connaissance des jeunes des interventions numériques et de surmonter d'autres obstacles des soins.

Parenting during the COVID-19 pandemic: The sociodemographic and mental health factors associated with maternal caregiver strain.

INTRODUCTION: The COVID-19 pandemic has introduced new stressors for parents ("caregivers") that may affect their own and their child's mental health (MH). We explored self-reported levels of caregiver strain (parents' perceived ability to meet parenting demands), and the MH and sociodemographic factors of caregivers to identify predictors of strain that can be used to guide MH service delivery for families. METHODS: We administered a web-based survey to Ontario caregivers with a child between 4 and 25 years old, between April and June 2020. We analyzed information from 570 maternal caregivers on their sociodemographics, youngest (or only) child's MH, their own MH, and the degree of caregiver strain experienced since the pandemic. We used linear regressions (unadjusted and adjusted models) to explore the relationship between caregiver strain and sociodemographics, child MH and caregiver MH. RESULTS: Over 75% of participants reported "moderate-to-high" caregiver strain. More than 25% of caregivers rated their MH as "poor" and 20% reported moderate-to-severe anxiety. Forty-five percent of the variance in caregiver strain was accounted for by child age, caregiver anxiety, and multiple child and caregiver MH variables. Younger child age and higher caregiver anxiety were the greatest predictors of caregiver strain. CONCLUSION: We found a relationship between child age, child and caregiver MH variables, and caregiver strain. Given the interrelatedness of these factors, supporting caregivers' MH and lessening their role strain becomes critical for family well-being. Evidence-based individual, family, and public health strategies are needed to alleviate pandemic-related strain. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal.

Research emphasizes the importance of asking about suicidality. Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes. We reviewed and rated seventeen studies and conducted a systematic review and random-effects meta-analysis on eight studies comparing those asked vs. not asked on immediate and later SRB, NSSI, and psychological distress (PD). Forest plots demonstrated no statistically significant effects of asking on SRB, NSSI, or PD. Eight RCTs provided the strongest evidence and demonstrated either low or unclear risk of bias, and the remaining cohort studies were of low to moderate quality. With the current available evidence, we found no harmful outcomes of asking, however more RCTs with a low risk of bias are required to firmly conclude that asking through self-report and interview methods does not further exacerbate distress, SRB and NSSI compared to those not asked.

The HEADS-ED: Evaluating the Clinical Use of a Brief, Action-Oriented, Pediatric Mental Health Screening Tool.

OBJECTIVES: This effectiveness study aimed to evaluate the clinical use of the HEADS-ED tool for patients presenting to a pediatric emergency department (PED) for mental health (MH) care. METHODS: In this pragmatic trial, PED physicians used the HEADS-ED to guide their assessment and identify areas of MH need in 639 patients (mean [SD], 15.16 [1.40] years; female, 72.6%) who presented to the emergency department with MH concerns between May 2013 and March 2014. RESULTS: The HEADS-ED guided consultation to psychiatry/crisis, with 86% receiving a recommended consult. Those with a HEADS-ED score of greater than or equal to 8 and suicidality of 2 (relative risk, 2.64; confidence interval, 2.28-3.06) had a 164% increased risk of physicians requesting a consult compared with those with a score of less than 8 or greater than or equal to 8 with no suicidality of 2. The HEADS-ED mean score was significantly higher for those who received a consult (M = 6.91) than those who did not (M = 4.70; P = 0.000). Similarly, the mean score for those admitted was significantly higher (M = 7.21) than those discharged (M = 5.28; P = 0.000). Agreement on needs requiring action between PED physicians and crisis intervention workers was obtained for a subset of 140 patients and ranged from 62% to 93%. CONCLUSIONS: Results support the HEADS-ED's use by PED physicians to help guide the assessment and referral process and for discussing the clinical needs of patients among health care providers using a common action-oriented language.

Family Factors and Repeat Pediatric Emergency Department Visits for Mental Health: A Retrospective Cohort Study.

OBJECTIVES: Approximately 45% of youth presenting to the emergency department (ED) for mental health (MH) concerns will have a repeat ED visit. Since youth greatly depend on their caregivers to access MH services, the objective of this study was to determine if family characteristics were associated with repeat ED visits. METHODS: A retrospective cohort study of youth aged 6-18 years (62% female) treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Family factor contribution was analyzed using a multivariable logistic regression model controlling for demographic, clinical and service utilization factors. Variables associated with earlier and more frequent visits were determined using cox regression and negative binomial regression. RESULTS: Of 266 participants, 70 (26%) had a repeat visit. While caregiver history of MH treatment decreased the odds of having a repeat ED visit, family functioning and perceived family burden were not associated with repeat visits. Post-visit MH services, prior psychiatric hospitalization, higher severity of symptoms, and living closer to the hospital increased the odds of repeat visits. CONCLUSIONS: This study examined the contribution of multiple family factors in predicting repeat MH visits to the ED. Results suggest caregiver characteristics may impact the decision to return. Healthcare providers should therefore consider caregiver and youth service utilization factors to inform patient management and discharge planning.

OBJECTIFS: Environ 45 % des adolescents qui se présentent au service d'urgence (SU) pour des raisons de santé mentale (SM) auront une visite répétée au SU. Puisque les adolescents dépendent beaucoup de leurs aidants pour avoir accès aux services de SM, l'objectif de cette étude était de déterminer si les caractéristiques familiales étaient associées aux visites répétées au SU. MÉTHODES: Une étude de cohorte rétrospective a été menée sur des adolescents de 6 à 18 ans (62 % de sexe féminin) traités dans un SU pédiatrique tertiaire pour un diagnostic lié à la SM posé au moment du congé. Les données ont été recueillies d'après les dossiers médicaux, les entrevues téléphoniques et les questionnaires. La contribution des facteurs familiaux a été analysée à l'aide d'un modèle de régression logistique multivariable après contrôle des facteurs démographiques, cliniques et d'utilisation des services. Les variables associées à des visites précédentes et plus fréquentes ont été déterminées à l'aide de la régression de Cox et la régression binomiale négative. RÉSULTATS: Sur les 266 participants, 70 (26 %) avaient une visite répétée. Les antécédents de traitement de SM des aidants diminuaient les probabilités d'avoir une visite répétée au SU, et le fonctionnement familial et le fardeau familial perçu n'étaient pas associés à des visites répétées. Les services de SM ultérieurs à la visite, une hospitalisation psychiatrique précédente, une gravité plus élevée des symptômes et le fait d'habiter à proximité de l'hôpital augmentaient les probabilités de visites répétées. CONCLUSIONS: Cette étude a examiné la contribution de multiples facteurs familiaux à la prédiction de visites répétées au SU pour raisons de SM. Les résultats suggèrent que les caractéristiques des aidants puissent influer sur la décision de retourner au SU. Les prestataires de soins de santé devraient donc prendre en compte les facteurs d'utilisation des services des aidants et des adolescents afin d'éclairer la prise en charge des patients et la planification du congé.

Evaluating the HEADS-ED Screening Tool in a Hospital-Based Mental Health and Addictions Central Referral Intake System: A Prospective Cohort Study.

OBJECTIVES: We evaluated the use of a mental health (MH) screening tool in a hospital-based centralized MH referral telephonic intake process. The tool is used to guide psychosocial screening in several domains: home; education; activities and peers; drugs and alcohol; suicidality; emotions, thoughts, and behaviors; and discharge resources (HEADS-ED). We wanted to understand the use of the tool to guide next step in care decision-making over the telephone. METHODS: Intake workers used the HEADS-ED tool to guide the assessment processes, identified areas of MH need, and made decisions about next step in care. We completed a retrospective chart review of all callers to the intake system over 4 months to gather initial decision at intake and subsequent steps in treatment. χ2 and analysis of variance tests were used to examine differences between HEADS-ED scores and next step in care. RESULTS: A total of 674 patients aged 3 to 19 years (mean age = 11.7 years, SD = 0.6; girls = 50.0%) called for services. Significant mean differences were found on total HEADS-ED scores between treatment options (F4,641 = 75.76; P < .001). Decision validity indicated that 86% (n = 506 of 587) of initial referrals matched treatments that were actually received. Uptake of the tool was 100%, and interrater reliability indicated strong agreement between raters (intraclass correlation coefficient = 0.82; P < .001). CONCLUSIONS: With our results, we support the use of the HEADS-ED tool in a telephone-based MH intake system to help guide the initial assessment and inform decision-making about fit of next step in care, both within the health center-based MH system and in the community.

Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth.

OBJECTIVES: The goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed. METHODS: A 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher's exact test to compare sites. RESULTS: The cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed. CONCLUSIONS: Children and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.

An Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions.

Children and youth presenting to the emergency department with mental health concerns present a challenge for clinicians and system capacity. Addressing a significant system gap and sparse strategies in the literature, representative leaders from hospital and community agencies developed a novel pathway to guide efficient and doable risk assessment and ensure timely transition to appropriate community mental health services. This article describes and reflects on our innovative Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions that bridges traditional barriers between hospital and community settings to address mental health needs for this population.

Child and Adolescent Mental Health Repeat Visits to the Emergency Department: A Systematic Review.

OBJECTIVES: Repeat visits represent up to 45% of mental health (MH) presentations to emergency departments (EDs) and are associated with higher health care costs. We aimed to synthesize available literature on predictors of pediatric MH repeat ED visits and differences between repeat visitors and nonrepeat visitors. METHODS: A systematic review was performed using PsycINFO, PubMed, and CINAHL databases. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist. Methodologic quality was assessed using the following 8 criteria: design, generalizability, breadth of predictors, reporting of effect sizes, additional outcomes, interaction terms, confounding variables, and clear definition of repeat visits. RESULTS: A total of 178 articles were retrieved; 11 articles met inclusion criteria. Quality assessment revealed that all studies used chart review or administrative data. Predictors were grouped into 3 categories: demographic, clinical, and MH care access and utilization factors. Common predictors associated with repeat ED MH visits included socioeconomic status, involvement with child protective services, and previous and current MH service use. For studies using a 6-month repeat window, the most common factors were previous psychiatric hospitalization and currently receiving MH services. Heterogeneity in statistical analyses and determinants explored precluded the use of meta-analysis. CONCLUSIONS: Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. To further elucidate the strongest predictors, future prospective research should consider prospective designs and include family factors. Investigating recency and frequency outcomes can also inform clinical practice.