Using Digital Measurement-Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data.

BACKGROUND: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. OBJECTIVE: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. METHODS: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). RESULTS: Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement. CONCLUSIONS: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc.

Using Digital Measurement-Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. OBJECTIVE: The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. METHODS: Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). RESULTS: Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. CONCLUSIONS: This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.

Real-Time Mental Health Crisis Response in the United States to COVID-19.

Background: Data are scarce on assessing the impact of the COVID-19 pandemic on young people. Aim: To examine changes in crisis text patterns in the United States during the pandemic compared to the prepandemic period. Method: Nonintrusive data from a national digital crisis texting platform were analyzed using an interrupted time series design. Poisson regression with repeated-measures examined help-seeking patterns for stress, anxiety, depression, suicidal thoughts, and other mental health concerns in the pandemic (March 13 to July 20, 2020) compared to the prepandemic period (March 13 to July 20, 2019). Results: An abrupt increase in national crisis response texts occurred during the pandemic for stress and anxiety, substance abuse, bereavement, isolation, and abuse compared to the prepandemic period. Similar trends of excess texts for isolation and abuse were reported among children (relative risk [RR]abuse: 1.16, CI: 1.03, 1.31; RRisolation: 1.15, CI: 1.09, 1.21) and adolescents (RRabuse: 1.17, CI: 1.11, 1.24; RRisolation: 1.08, CI: 1.05, 1.11), bereavement among Black (RR: 1.31, CI: 1.12, 1.54) and Hispanic (RR: 1.28, CI: 1.10, 1.49) texters, and isolation and bereavement in female (RRisolation: 1.09, CI: 1.06, 1.11; RRbereavement: 1.21, CI: 1.13, 1.28) or nonconforming youth (RRisolation: 1.19, CI: 1.08, 1.32; RRbereavement: 1.50, CI: 1.08, 2.09) texters. Conversely, the risks of reporting bullying, depression, relationship issues, and suicidal thoughts as reasons for texting were significantly lower during COVID-19. Limitations: Results may underestimate crisis support-seeking in some groups because demographic data were not captured on all texters. Conclusion: Findings illuminated the real-time crisis response of young people across the United States and can inform more responsive interventions to alleviate the mental health consequences brought on by the COVID-19 pandemic.

Crisis Response and Suicidal Patterns in U.S. Youth Before and During COVID-19: A Latent Class Analysis.

PURPOSE: This study characterized the unobserved patterns in crisis response among youth in the U.S. from March to December 2020 and determined the characteristics of vulnerable subgroups who were at increased risk for suicide due to the pandemic. METHODS: A latent class analysis of crisis support-seeking from a national text-based crisis platform, (n = 179,497, aged 24 years or younger) for 11 crisis concerns (e.g., depression, anxiety/stress, suicidal thoughts, isolation, abuse, bereavement, relationships) was performed on three study periods: (1) January 2017 to December 2020, (2) prepandemic: 1 January 2017 to 12 March 2020, and (3) pandemic: 13 March to 20 December 2020. Demographic characteristics (age, race/ethnicity, sexual orientation, and gender identity) were used as predictors for class membership using the three-step method. RESULTS: Four latent classes were identified: (1) depression/isolation/self-harm (D/I/S) (18,694 texters, 10.4%), (2) interpersonal stress/mood-anxiety (I/M) (32,640 texters, 18.2%), (3) suicidal thoughts/depressed (S/D) (34,067, 19.0%), and (4) adjustment/stress (A/S) (94,096 texters, 52.4%). During the pandemic, an increase in suicidal thoughts and active rescues occurred in the D/I/S and S/D higher-risk subclasses. Characteristics of vulnerable groups in higher-risk classes since the pandemic included children, LGBTQ, American Indian, White, Black, Asian, female, and gender-nonconforming youth. CONCLUSIONS: Results identified a strong association with class membership in more severe risk classes during the pandemic and an increase in suicidal help-seeking, particularly among children and LGBTQ youth. Low-cost and targeted crisis text-based platforms for support-seeking in youth may be one potential safety net strategy to address the effects of the COVID-19 pandemic on mental health in youth.

Crisis response among essential workers and their children during the COVID-19 pandemic.

Limited research has been conducted on the mental health concerns of frontline and essential workers and their children during the COVID-19 pandemic in the United States (U.S.). This study examined the association between working on the frontlines in the U.S. during the COVID-19 pandemic (March to July 2020) and personal crisis text concerns (e.g., self-harm, suicidal thoughts, anxiety/stress, and substance abuse) for frontline essential workers and the children of frontline workers. We used a novel data set from a crisis texting service, Crisis Text Line (CTL), that is widely used throughout the U.S. Generalized Estimating Equations examined the individual association between eight specific crisis types (Depression, Stress/Anxiety, Self-Harm, Suicidal Thoughts, Substance Abuse, Isolation, Relationship Issues, and Abuse) and being in frontline work or being a child of a frontline worker during the early phase of the pandemic. Using CTL concerns as a proxy for the prevalence of mental health issues, we found that children of workers, specifically the youngest demographic (13 years and under), females, and non-conforming youth had a higher risk of specific crisis events during the COVID-19 pandemic. Additionally, Hispanic children of workers reported higher rates of stress/anxiety, whereas African American children of workers had higher rates of abuse and depression. Frontline workers had a higher risk of suicidal thoughts, and the risk of crisis events was generally highest for non-binary, transgender, and male users. Increases in CTL usage among frontline workers were noted across 7-28 days after spikes in local COVID-19 cases. The research to date has focused on the mental health of frontline essential workers, but our study highlights troubling trends in psychological stress among children of these workers. Supportive interventions and mental health resources are needed not only for frontline essential workers, but for their children too.

Spatial Clustering of Adolescent Bereavement in the United States During the COVID-19 Pandemic.

PURPOSE: Few studies have examined grief and bereavement in the context of a pandemic, particularly among young people during the ongoing COVID-19 pandemic. METHODS: The objective of this study is to examine spatiotemporal clustering of bereavement using data from Crisis Text Line, an SMS-based intervention with widespread usage among youth and adolescents in the United States from January 2017 to September 2020. RESULTS: Results found significant spatial clustering of bereavement during the pandemic period in the late summer months compared with the onset of the pandemic. CONCLUSION: Our study provides the first evidence of elevated bereavement in adolescents using a technique for rapidly identifying clusters of bereavement risk among this vulnerable subgroup. Findings can be leveraged for targeted interventions and supportive counseling in geographic hotspots.

Crisis text patterns in youth following the release of 13 Reasons Why Season 2 and celebrity suicides: A case study of 2018.

There is considerable debate in the public arena and among the professional mental health community around the media's role in increasing suicide risk following exposure to suicide-themed media in youth. A recent example involves the concerning reaction to the release of Netflix's controversial hit teen-suicide drama 13 Reasons Why. This follow-up study examined the association between the release of 13 Reasons Why Season 2 (13RW2), which coincided with two celebrity suicides, and national trends in crisis-related text conversations. We implemented an interrupted time series design to examine changes in daily counts of crisis texts aggregated at the national level following two events: (1) the release of 13RW2 and (2) celebrity suicide deaths of Anthony Bourdain and Kate Spade. We also performed a sub-analysis of suicide-related crisis conversations following each event. Crisis conversation volume was 42% higher after the release of 13RW2 for 6 of the 18 days of the study period, while crisis text usage was 51% higher for 9 out of the 18 days after the publicized celebrity suicide deaths. Both the release of 13RW2 and the celebrity suicides in the summer of 2018 were followed by an abrupt, but transient rise in crisis help-seeking among adolescents. Media outlets should consider pairing suicide-themed content with crisis support services as a core best practice to reduce the risk of population-level adverse reactions to suicide portrayals or coverage.