Despite available depression treatments, only one fourth to one third of depressed adolescents are receiving care. The problem of underdiagnosis and underreferral might be redressed if assessment of suicidality and depression became a more formal part of routine pediatric care. Our purpose for this study was to explore the feasibility and acceptability of implementing adolescent depression screening into clinical practice.
In this study we implemented a 2-stage adolescent identification protocol, a first-stage pen-and-paper screen and a second-stage computerized assessment, into a busy primary care pediatric practice. Providers tracked the number of eligible patients screened at both health maintenance and urgent care visits and provided survey responses regarding the burden that screening placed on the practice and the effect on patient/parent-provider relationships.
Seventy-nine percent of adolescent patients presenting for health maintenance visits were screened, as were the majority of patients presenting for any type of visit. The average completion time for the paper screen was 4.6 minutes. Providers perceived parents and patients as expressing more satisfaction than dissatisfaction with the screening procedures and that the increased time burden could be handled. All providers wished to continue using the paper screen at the conclusion of the protocol.
Instituting universal systematic depression screening in a practice with a standardized screening instrument met with little resistance by patients and parents and was well perceived and accepted by providers.
"In addition, at least one neuropsychiatric manifestation was identified in 91% of the SLE patients and in 54% of the controls, with a 9.5 fold increase in risk, a specificity of 0.46 and a detection rate of 91% among SLE patients. Headache, anxiety, mild depression, mild cognitive impairment and polyneuropathy are common in otherwise healthy subjects and even more so among patients with a chronic disease  , making the attribution of such symptoms to SLE itself a challenge in those settings. Taking into account the high prevalence of some NP manifestations in both SLE and control groups, they set up a different model excluding headache, anxiety, mild depression, mild cognitive impairment and polyneuropathy without electrophysiological confirmation. "
[Show abstract][Hide abstract] ABSTRACT: Central nervous system (CNS) involvement is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE) patients. Clinical manifestations can involve both the central and peripheral nervous systems, and they must be differentiated from infections, metabolic complications, and drug-induced toxicity. Recognition and treatment of CNS involvement continues to represent a major diagnostic challenge. In this Review, we sought to summarise the current insights on the various aspects of neuropsychiatric SLE with special emphasis on the terminology and classification criteria needed to correctly attribute the particular event to SLE.
"At the same time, obtaining reimbursement for these services remains a very real barrier to implementation by psychologists (Noll & Fischer, 2004). Third, there are often attitudinal barriers among physicians and other health care providers to instituting psychosocial screening for children with a chronic illness (Varni, Burwinkle, & Lane, 2005; Zuckerbrot et al., 2007). There may be reluctance to screen because of the presumed stigma associated with receiving psychological services. "
[Show abstract][Hide abstract] ABSTRACT: Psychosocial factors are strongly associated with long-term medical and mental health outcomes for children with Type 1 diabetes. As a result, current national and international guidelines now call for psychosocial screening at or near the time of diabetes diagnosis. Despite this recommendation, there are no published protocols to provide guidance to psychologists attempting to screen and identify at-risk patients and their families and prevent the emergence of secondary psychological and medical complications. In this article, the authors describe a model psychosocial screening program that was designed to minimize barriers to implementation and that can potentially be adapted for use by psychologists in different settings. Preliminary findings from the pilot phase of program development suggest that the screening is effective at identifying patients at risk for subsequent problems with diabetes management. The screening was able to identify specific, modifiable risk factors that provide targets for efforts at preventive intervention using treatment approaches familiar to most psychologists. The authors conclude with a discussion of the importance of screening and knowledge of diabetes risk factors for psychologists working in different treatment settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Professional Psychology Research and Practice 07/2011; 42(4):324-330. DOI:10.1037/a0023836 · 1.34 Impact Factor
"At the same time, data from the Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group have shown that good metabolic control early in the course of the illness has a protective effect against later complications (2). Youth with diabetes are also at increased risk for serious mental health concerns, such as depression (3), that are often underdiagnosed (4). "
[Show abstract][Hide abstract] ABSTRACT: Psychosocial screening has been recommended for pediatric patients with newly diagnosed type 1 diabetes and their families. Our objective was to assess a psychosocial screening protocol in its feasibility, acceptability to families, and ability to predict early emerging complications, nonadherent family behavior, and use of preventive psychology services.
A total of 125 patients and their caregivers were asked to participate in a standardized screening interview after admission at a large urban children's hospital with a new diagnosis of type 1 diabetes. Medical records were reviewed for subsequent diabetes-related emergency department (ED) admissions, missed diabetes clinic appointments, and psychology follow-up within 9 months of diagnosis.
Of 125 families, 121 (96.8%) agreed to participate in the screening, and a subsample of 30 surveyed caregivers indicated high levels of satisfaction. Risk factors at diagnosis predicted subsequent ED admissions with a sensitivity of 100% and a specificity of 98.6%. Children from single-parent households with a history of behavior problems were nearly six times more likely to be seen in the ED after diagnosis. Missed appointments were likeliest among African Americans, 65% of whom missed at least one diabetes-related appointment. Psychology services for preventive intervention were underutilized, despite the high acceptability of the psychosocial screening.
Psychosocial screening of newly diagnosed patients with type 1 diabetes is feasible, acceptable to families, and able to identify families at risk for early emerging complications and nonadherence. Challenges remain with regards to reimbursement and fostering follow-up for preventive care.
Diabetes care 02/2011; 34(2):326-31. DOI:10.2337/dc10-1553 · 8.42 Impact Factor
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