Predictors of Psychological Distress in Health Care Staff in Qatar during COVID-19 Pandemic.

BACKGROUND & OBJECTIVE: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. METHODS: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. RESULTS: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P <0.01). Female gender was a predictor for experiencing fear of getting infected. Time constraints at work was the most common reason for not accessing mental health support. CONCLUSIONS: As in other parts of the world, hospital staff in Qatar experienced mental health symptoms and significant fear related to the COVID-19 Pandemic. Being single and in poor health status were risk factors. Mental health interventions at work must take into account time constraints experienced by staff.

Risk of suicide in children and adolescents in the emergency department-is universal screening the answer?

OBJECTIVE: Suicide is a leading cause of death among children and adolescents. Suicide risk screening tools can detect the risk of suicide among patients presenting to healthcare settings. The aim of this review was to describe the effectiveness of universal suicide risk screening (all patients) compared with selective screening (behavioural health patients only) in children and adolescents in emergency departments (EDs). METHOD: A literature search was conducted on PubMed for articles related to suicide risk screening in paediatric EDs between January 2016 and February 2022. RESULTS: 8 studies met the selection criteria. The review showed that 46%-93% of patients that screened positive for suicide risk had presented with a medical concern. These patients would have been missed without universal suicide risk screening. In both selective and universal screening scenarios, use of a suicide risk screening tool was better at detecting suicide risk compared with use of presenting problem alone. Suicide risk screening was found to be acceptable without increasing length of stay in the ED. CONCLUSION: Based on this review, using a suicide screening tool can help detect patients at risk who would otherwise have been missed.

Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach.

OBJECTIVE: The aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children's hospital. METHODS: We developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data. RESULTS: The model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5-54.3 days; ED: 94.4 days; 95% CI, 92.6-96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8-279.0 days). CONCLUSIONS: The DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow.

Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management.

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

The Development of a BMI-Guided Shape Morphing Technique and the Effects of an Individualized Figure Rating Scale on Self-Perception of Body Size.

The creation of personalized avatars that may be morphed to simulate realistic changes in body size is useful when studying self-perception of body size. One drawback is that these methods are resource intensive compared to rating scales that rely upon generalized drawings. Little is known about how body perception ratings compare across different methods, particularly across differing levels of personalized detail in visualizations. This knowledge is essential to inform future decisions about the appropriate tradeoff between personalized realism and resource availability. The current study aimed to determine the impact of varying degrees of personalized realism on self-perception of body size. We explored this topic in young adult women, using a generalized line drawing scale, as well as several types of personalized avatars, including 3D textured images presented in immersive virtual reality (VR). Body perception ratings using generalized line drawings were often higher than responses using individualized visualization methods. While the personalized details seemed to help with identification, there were few differences among the three conditions containing different amounts of individualized realism (e.g., photo-realistic texture). These results suggest that using scales based on personalized texture and limb dimensions are beneficial, although presentation in immersive VR may not be essential.

Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines.

OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children's hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation. RESULTS: Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment. CONCLUSIONS: A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.

Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings.

Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.

Psychological Impact of Nuclear Disasters in Children and Adolescents.

Although much has been written about the psychological impact of natural disasters, the impact of nuclear disasters has not been extensively studied in children. Nuclear disasters are unique because they are man-made and represent a failure of the safety systems put in place to contain dangerous radioactive materials. This article summarizes the available literature on 3 of the biggest nuclear disasters in history. There is a need for further investigation not only of the impact on children but also of whether the consequences are a direct result of the disaster, radiation exposure, or the psychosocial disruptions resulting from the disaster.