Elevated prevalence of antisocial behavior in adolescent children whose mothers misuse opioids.

BACKGROUND: Past studies show that illicit opioid use may impair parents' ability to care for their children. However, few studies have examined adverse outcomes in adolescent children of mothers who misuse opioids. METHODS: Data come from the National Survey on Drug Use and Health's nationally representative matched sample of mothers and their adolescent children who resided in the same household. The outcome of interest was whether adolescents engaged in aggressive or antisocial behaviors in the past year. Using logistic regression, adolescent children whose mothers engaged in past-year opioid misuse were respectively compared to children whose mothers used other illicit drugs, had an alcohol use disorder, or had no misuse of substances. To control for confounding, propensity scores were used to match the three other maternal substance use groups to mothers who misused opioids on a number of measured confounding variables. RESULTS: The odds of antisocial behaviors were 1.6 times higher among adolescent children whose mother engaged in past-year opioid misuse than matched adolescent children whose mothers reported no illicit substance use. There was no significant difference in antisocial behaviors between adolescents whose mothers misused opioids and either adolescents whose mothers used illicit drugs or had an alcohol use disorder. CONCLUSION: As the United States seeks to respond to the needs of families impacted by its ongoing opioid crisis, it is likely that services will be needed not only for parents who misuse opioids, but also for their children, who are at elevated risk for adverse behavioral outcomes.

State-Level Prevalence of Bullying Victimization Among Children and Adolescents, National Survey of Children's Health, 2016-2017.

Bullying is a serious public health issue among children and adolescents in the United States. The purpose of this study was to estimate the prevalence of bullying victimization (defined as a child being bullied, picked on, or excluded by children) in the 50 states and the District of Columbia. We used data on bullying victimization from the 2016-2017 National Survey of Children's Health (NSCH). We stratified the sample by age: children aged 6-11 years (n = 21 142) and adolescents aged 12-17 years (n = 29 011). We conducted bivariate analyses to determine the prevalence of bullying victimization by state for each age group. In the survey, parents/caregivers responded to a question about whether it was "definitely true," "somewhat true," or "not true" that their child "is being bullied, picked on, or excluded by other children." We combined "definitely true" and "somewhat true" responses to create a dichotomous variable for bullying victimization. Parents reported 22.4% of children aged 6-11 years and 21.0% of adolescents aged 12-17 years as experiencing bullying victimization during 2016-2017. The prevalence of bullying victimization among children ranged from 16.5% in New York State to 35.9% in Wyoming and among adolescents ranged from 14.9% in Nevada to 31.6% in Montana. The prevalence of bullying victimization among children or adolescents was >30% in 7 states: Arkansas, Kentucky, Maine, Montana, North Dakota, South Dakota, and Wyoming. These data can be used to inform state programs and policies to support bullying prevention efforts and services for children and adolescents who experience bullying. NSCH will continue to collect data on bullying victimization to track annual trends in national and state-level prevalence rates among children and adolescents.

Differences in Utilization of Mental Health Treatment Among Children and Adolescents With Medicaid or Private Insurance.

OBJECTIVE: Children and adolescents with diagnosed mental disorders may require developmentally tailored interventions. However, little is known about the difference in mental health treatment utilization among children by age group and health insurance coverage. METHODS: Using the 2016 MarketScan database, the study examined treatment utilization patterns by health insurance coverage (private and Medicaid) and developmental age group (preschool-age children, ages 3-5; young children, ages 6-11; and adolescents, ages 12-17). RESULTS: Psychiatric medication only was the most common form of treatment utilization among all children, regardless of developmental age group or insurance coverage. Specifically, psychiatric medication only was received by 38% of preschool-aged children with Medicaid and 42% of those with private insurance, 43% of young children with Medicaid and 39% of those with private insurance, and 55% of adolescents with Medicaid and 49% of those with private insurance. CONCLUSIONS: Given that evidence-based practices suggest that combined treatment with psychiatric medications and psychotherapy may be the recommended treatment, the study's findings raise potential concerns about the high use of medication-only treatment.

Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children.

OBJECTIVES: To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN: We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS: Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS: The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.

Diagnosis of Postpartum Depression and Timing and Types of Treatment Received Differ for Women with Private and Medicaid Coverage.

BACKGROUND: Postpartum depression is underdiagnosed and undertreated. The purpose of this study was to describe the prevalence and timing of depression diagnoses and treatment use in the year after childbirth among women with private and Medicaid health insurance coverage. METHODS: Using two large claims databases (private employer-sponsored and multistate Medicaid), we identified women with a live birth in 2014. We calculated the percentage of women with a depression diagnosis in the year after giving birth and identified their mental health treatment use (antidepressant medication filled and/or psychotherapy). We calculated days to diagnosis, days to treatment initiation, and number of therapy sessions. Percentages were compared using Cohen's h measure of effect size between two independent proportions (h ≥ 0.20 are meaningful). RESULTS: After childbirth, 7% of privately insured women and 13% with Medicaid were newly diagnosed with depression (h = 0.22). Those with Medicaid were diagnosed earlier (median 43 days vs. 78 days for private), but treatment initiation occurred later (h = 0.38) and at a lower rate (54% with Medicaid received some treatment vs. 71% with private insurance, h = 0.35). Many women received medication without therapy (44% with Medicaid vs. 51% with private insurance). Therapy was used more commonly by private enrollees (20% vs. 10% of Medicaid; h = 0.28). Among those who received therapy, the median was three sessions. CONCLUSIONS: Postpartum depression diagnosis was more prevalent among women with Medicaid coverage, yet the treatment gap was greater and initiation was later. These findings suggest that there is room for improvement when it comes to early intervention and treatment engagement.

Differential Reimbursement of Psychiatric Services by Psychiatrists and Other Medical Providers.

OBJECTIVE: Given low psychiatrist participation in insurance networks, this study examines how psychiatrists are reimbursed in network and out of network under commercial insurance relative to other providers for the same diagnoses and services. METHODS: Paid private insurance claims from the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounters Database were analyzed. The sample included all services billed for 3.8 million individuals with a mental disorder as the primary diagnosis by psychiatrists, nonpsychiatrist medical doctors, psychologists, social workers, or psychiatric nurses. The authors determined the most common services provided by each provider type, the median reimbursement and median out-of-pocket payment for the services by provider type and by network status (in or out of network), and the proportion of bills for services delivered out of network. RESULTS: "Evaluation and management" services for presenting problems of low to moderate and moderate to high severity were the two procedures most frequently billed by psychiatrists and nonpsychiatrist medical doctors. The median reimbursement for services for presenting problems of low to moderate and moderate to high severity was 13% less ($66 versus $76) and 20% less ($91 versus $114), respectively, for psychiatrists versus nonpsychiatrist medical doctors if the services were provided in network but 28% higher ($100 versus $78) and 6% higher ($122 versus $115), respectively, for psychiatrists versus nonpsychiatrist medical doctors for services provided out of network. CONCLUSIONS: Psychiatrists receive lower in-network reimbursement than nonpsychiatrist medical doctors for many of the same services. This may contribute to psychiatrists' lower participation in insurance networks relative to other providers and has implications for patient cost sharing and access to psychiatrists.

Marijuana buyers in the United States, 2010-2014.

BACKGROUND: Obtaining or purchasing marijuana in the U.S. can be done only in certain states via a lawful market for medical or non-medical (recreational) purposes, or via an unlawful market ("black market") by home cultivation and unlicensed vendors and individuals. Given the evolving U.S. state marijuana legislation landscape, the objective of this study is to describe individuals who report buying marijuana in the past year by selected characteristics and U.S. geographical location. METHODS: Using data from the 2010-2014 National Survey on Drug Use and Health (NSDUH), we conducted bivariate chi-square tests to examine sociodemographic and selected behavioral indicators associated with buying marijuana and analyzed these factors in a multivariable logistic regression model. NSDUH participants were the noninstitutionalized civilian population aged 12+ (approximately 62,100 individuals per year) who reported using marijuana in the past year (approximately 12,400 annual average). RESULTS: A weighted estimate of approximately 18.5 million individuals aged 12+ reported buying marijuana in the past year (59% of marijuana users). Overall, buyers of marijuana were more likely to be male, report using marijuana for a greater number of days, and to meet the criteria for substance use disorder and marijuana dependence. Data showed differences of proportion of marijuana buyers by state of residence. CONCLUSIONS: Given recent changes in state laws and policies and the increased demand for marijuana products, continued monitoring of the U.S. marijuana market in coming years is important in order to understand consumption and buying patterns among at-risk segments of the population, especially youth.

Effects of the 2013 Psychiatric Current Procedural Terminology Codes Revision on Psychotherapy in Psychiatric Billing.

OBJECTIVE: The purpose of this study was to determine whether the changes to the psychiatric Current Procedural Terminology (CPT) codes implemented in 2013 were associated with changes in types of services for which psychiatrists billed. METHODS: Analyses were conducted using paid private insurance claims from a large commercial database. The participant cohort comprised psychiatrists with at least one psychiatry visit reported in the database in each calendar year studied: 2012 (N of visits=778,445), 2013 (N=748,317), and 2014 (N=754,760). RESULTS: The percentage of visits in which psychiatrists billed for psychotherapy declined from 51.4% in 2012 to 42.1% in 2014. The decline held after the analyses adjusted for patient characteristics, plan type, and region. CONCLUSIONS: The update to CPT codes resulted in a decrease in visits for which psychiatrists billed for psychotherapy. Further research should explore whether the change in billing corresponds to changes in service delivery.

The development of negative reactivity in irritable newborns as a function of attachment.

This longitudinal study builds on existing research exploring the developmental course of infants' negative reactivity to frustration in a sample of 84 irritable infants. We investigated whether infants' negative reactivity to frustration differed during the first year as a function of infant attachment classification. Various elements of the designs of previous studies investigating negative reactivity and attachment preclude the strong conclusion that negative reactivity develops differently as a function of attachment. Thus, we utilized the same observational assessment of infant negative reactivity, conducted without parental involvement, at 5 and 12 months. One proposition, based in attachment theory (Bowlby, 1969/1982; Cassidy, 1994), is that relative to secure infants, insecure-avoidant infants come to minimize their negative emotional reactions, whereas insecure-ambivalent infants come to maximize their negative emotional reactions. As expected, we found that at 5 months, attachment groups did not differ in reactivity, but at 12 months, insecure-avoidant infants were the least reactive, followed by secure infants, and insecure-ambivalent infants were the most reactive. Results are discussed in terms of conceptualizing the development of emotion regulation and their implications for future research.

What's in a word? Linguistic characteristics of Adult Attachment Interviews.

In the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984), state of mind with respect to attachment is assessed not on the basis of the content of the participant's narrative, but rather on the basis of the narrative's linguistic properties. The present study is the first to further explore linguistic characteristics of attachment state of mind in AAI narratives by examining participants' frequency of word usage within the categories of the Linguistic Inquiry Word Count text analysis program (LIWC; Pennebaker, Booth, & Francis, 2007). LIWC uses an internal dictionary to count words in conceptual categories and creates proportion scores for each category based on the total word count. Results from an examination of the AAI transcripts of 136 first-time mothers of infants indicated that (a) participants with secure, dismissing, and preoccupied AAI classifications significantly differed in their use of 14 of the 44 LIWC categories examined; (b) 10 LIWC categories were significantly correlated with AAI coherence of mind; and (c) AAI group assignment based on LIWC linguistic profiles yielded 71% agreement with AAI coders. We drew from existing AAI and LIWC research to interpret and discuss these intriguing findings.

Newborn irritability moderates the association between infant attachment security and toddler exploration and sociability.

This longitudinal investigation of 84 infants examined whether the effect of 12-month attachment on 18- and 24-month exploration and sociability with unfamiliar adults varied as a function of newborn irritability. As expected, results revealed an interaction between attachment (secure vs. insecure) and irritability (highly irritable vs. moderately irritable) in predicting both exploration and sociability with unfamiliar adults. For exploration, results supported a dual-risk model; that is, toddlers who had been both highly irritable and insecurely attached were less exploratory than other toddlers. For sociability, results supported the differential-susceptibility hypothesis; that is, highly irritable infants, compared to moderately irritable infants, were both less sociable as toddlers when they had been insecurely attached and more sociable when they had been securely attached.

Enhancing infant attachment security: an examination of treatment efficacy and differential susceptibility.

This randomized controlled trial examined (a) the efficacy of a brief intervention designed to increase the rate of secure infant attachment, (b) the differential susceptibility hypothesis, and (c) whether maternal attachment styles moderated the expected Treatment x Irritability interaction in predicting infant attachment outcomes. Although there was no main effect of treatment, a significant Treatment x Irritability interaction revealed intervention effects for the highly irritable infants only, thus supporting one of two predictions of the differential susceptibility hypothesis: highly irritable infants would have disproportionately better outcomes than moderately irritable infants in better conditions (i.e., with intervention). When separate analyses were conducted with maternal attachment styles, we found significant three-way interactions among treatment, irritability, and each of the examined maternal attachment style dimensions (i.e., secure-fearful and dismissing-preoccupied). Specifically, with more secure mothers, beneficial effects of intervention emerged for highly irritable infants. For more dismissing mothers, the results revealed support for both predictions of the differential susceptibility hypothesis: highly irritable infants, compared to moderately irritable infants, were both more likely to be secure with intervention and less likely to be secure when in the control group. It is interesting that, for more preoccupied mothers, a treatment effect emerged only for moderately irritable infants. We discuss the implications of these findings for the differential susceptibility hypothesis as well as for early intervention.

Enhancing attachment security in the infants of women in a jail-diversion program.

Pregnant female offenders face multiple adversities that make successful parenting difficult. As a result, their children are at risk of developing insecure attachment and attachment disorganization, both of which are associated with an increased likelihood of poor developmental outcomes. We evaluated the outcomes of participants in Tamar's Children, a 15-month jail-diversion intervention for pregnant, nonviolent offenders with a history of substance abuse. All women received extensive wrap-around social services as well as the Circle of Security Perinatal Protocol (Cooper, Hoffman, & Powell, 2003). We present data on 20 women and their infants who completed the full dosage of treatment (a residential-living phase from pregnancy until infant age six months and community-living phase until 12 months). Results indicated that (1) program infants had rates of attachment security and attachment disorganization comparable to rates typically found in low-risk samples (and more favorable than those typically found in high-risk samples); (2) program mothers had levels of maternal sensitivity comparable to mothers in an existing community comparison group; and (3) improvement over time emerged for maternal depressive symptomatology, but not other aspects of maternal functioning. Given the lack of a randomized control group, results are discussed in terms of the exploratory, program-development nature of the study.